The Journey to Accountable Care
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ELLIOTT S. FISHER, MD, MPH JAMES W. SQUIRES PROFESSOR OF MEDICINE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH DIRECTOR THE DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE THE JOURNEY TO ACCOUNTABLE CARE
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The Journey to Accountable Care. Variations in Practice and Spending: Implications for Reform. An additional 1 in 5 patients survive. Delivering safe reliable, and effective care. Cost decreases by $20,000 per patient. Avoiding unnecessary care (hospital stays, visits, tests). - PowerPoint PPT Presentation
Transcript of The Journey to Accountable Care
ELLIOTT S. FISHER, MD, MPHJAMES W. SQUIRES PROFESSOR OF MEDICINEGEISEL SCHOOL OF MEDICINE AT DARTMOUTH
DIRECTORTHE DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE
THE JOURNEY TO ACCOUNTABLE CARE
Variations in Practice and Spending: Implications for Reform
An additional 1 in 5 patients
survive
Delivering safereliable, and effective care
Cost decreases by $20,000 per patientAvoiding unnecessary care (hospital stays, visits, tests)
Source: The Dartmouth Atlas
Flawed conceptual model: Healthis produced by face-to-face visits with physicians. Care is fragmented.
New model: It’s the system. Establish organizations capable of redesigning practice and eliminating waste.
Wrong incentives reinforce model, reward fragmentation, induce overuse of unnecessary care.
Rethink our incentives: Realign incentives – both financial and professional – with aims.
Confusion about aims: Is it about money or something more?
Clarify aims: Better health, better care, lower costs – for patients and communities.
Absent or poor data leaves practice unexamined and unable to improve; choices uninformed by evidence.
Better information that engages physicians, supports improvement; informs consumers and patients.
Variations in Practice and Spending: Implications for Reform
Underlying Problem Key Principles
The Current Opportunity: Health Care Reform
Affordable Care Act Investments in public health Health information technology Expanded coverage New payment models
“No Outcome, No Income”
David NashDean, Jefferson School of Population Health
The Current Opportunity: ACOs
Core Ideas Population-based virtual budgets Real or virtual organizations Performance measurement Patient choice Accommodate diversity
Fisher ES, Staiger DO, Bynum JP, Gottlieb DJ. Creating accountable care organizations Health affairs 2007;26:w44-57.Fisher ES, McClellan MB, Bertko J, et al. Fostering accountable health care: moving forward in medicare. Health affairs 2009;28:w219-31.McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health affairs 2010;29:982-90.
What Will We Do? An Unfolding Story
ACOs: 2009 (21)
What Will We Do? An Unfolding Story
ACOs: 2013 (328)
Note: The sum of ACOs reflects the total number of unique, publicly identifiable, confirmed private-payer ACOs as of 08/2012 and public-payer ACOs as of 01/2013.
Might it work? The evidence so far…
Overall Duals
All PGP $114 $532 (1%) (5%)
Marshfield $642 $987 (9%) (11%)
Might it work? Encouraging population-based models of care
Primary care system
Patients with diabetes(and their caregivers)
Endocrinologists
Evidence review, updated monthlyCare pathways well-specifiedTechnology to support “right” careCare delivered by “right” provider
Might it work? For specialists
Project EchoSanjeev Arora, MD
Professor of Medicine,University of New Mexico
ELLIOTT S. FISHER, MD, MPHJAMES W. SQUIRES PROFESSOR OF MEDICINEGEISEL SCHOOL OF MEDICINE AT DARTMOUTH
DIRECTORTHE DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE
THE JOURNEY TO ACCOUNTABLE CARE
