August 28, 2014

What 650,000 air miles taught Jim Bonnette about accountable care

Daily Briefing

    The Daily Briefing's Clare Rizer spoke with Jim Bonnette, MD, who's joined the Advisory Board to lead the Advisory Board’s new Strategy Consulting practice. Jim shared his perspective on the industry, examples of innovative tactics for value-based care, and how he thinks members can implement efficient accountable care solutions. 

    Q: Can you talk a bit about your background? It's awfully diverse—you got into health care as a physician, initially.

    Jim Bonnette: I began practicing as an internist in California, which was for a long time a hotbed of managed care. And when things got bad in the 1990s, I got the worst of it.

    I saw it both from the practicing side as well as having been at an HMO. That helped me get a better perspective on care delivery—namely, what was effective and what wasn't working.

    From the start, I was struck that too many providers weren't flexible enough to their patients' needs. Especially because I saw that you really have to create different models of care for different types of patients—it's not one-size-fits-all.

    Q: You're not just a MD, of course. You've also been a consultant and executive, too.

    Bonnette: Throughout my career, I've worked in supply chain, clinical IT, and risk-management capacities, among other areas. I've had exposure to many different opportunities for change.

    In my last position, I was charged with growing out Oliver Wyman's provider practice in consulting globally. So, I built out a team and our international offices over three years. We did work all across the U.S. for accountable care and different care model implementations, and then did the same kind of work in the United Kingdom, France, Singapore, Indonesia, Saudi Arabia, Kuwait, and South America. 

    Q: That sounds like a lot of travel.

    Bonnette: I flew 650,000 miles last year...a bit too many.

    Q: On your trips abroad, did you see one country that stood out as a leader in accountable care? Perhaps a nation that the United States should study to model its value-based care initiatives?

    Bonnette: I've seen good things in each country, but nobody's got a complete system. Some things that are workable in certain cultures aren't workable in ours, and vice versa.

    There are two common underlying problems, however.

    First, every country has a rate of growth of their expenditure in health care that they can't tolerate. Second, the way we train our doctors does not encourage or enable physicians to manage populations with chronic problems.  

    No country that I've seen has set up effective systems to really manage chronically ill patients. None.

    But we have really good examples in the U.S. where we've experimented and created incredibly effective ways to care for people with chronic diseases. They are models that can be replicated, it's just that most systems don't know how to do it.

    The fundamentals of accountable care

    Thomas Cassels summarizes the forces driving accountable care, outlines the steps necessary for a hospital or health system to transition toward operating as an accountable care organization (ACO), and provides insight into the question of whether all providers must plan to become ACOs.

    Watch the video

    Q: Of course, health care leaders have always cared about planning and forecasting. Can you explain what's different about setting a strategy today?

    Bonnette: In the current health care climate, hospitals and health systems are being pushed to make one change after another. And at progressive organizations, it's not enough to simply react to each new challenge. Those executives are looking to map out a long-term, cohesive plan for how to deal with the changing market.

    That's the work that the strategy practice I'm creating for Advisory Board Consulting is really designed to do—build a roadmap for any organization grappling with the change in our industry.

    Given that we [in the health care sector] all buy into the necessity for change, leaders need to start asking, "In my organization, what do I have to do to get from where we are to where we need to be?"

    Q: What about hospitals that hesitate to move toward accountable care? How will the Strategy Consulting practice help the executives that don't know where to start?

    Bonnette: When I was talking about this stuff 10 years ago, I was getting all kinds of pushback. Funny, but now I don't ever get anyone pushing back about the need to do it.

    What I get now are questions about how to do it. I typically recommend the patient-centered discussion: How do we best serve a population of patients?

    So, what attracted me to the Advisory Board in the first place is the way the company can answer this question—from a variety of available resources from the entire firm at-large. You've got best practice research and solutions from the research arm, then Crimson's technology, and then the tactical and now strategic arm of Advisory Board Consulting. Through a combination of these resources, the firm can create a blueprint for our members and drive them forward.

    Related: Why access is the key to attracting and retaining patients

    I'm sensitive that some doctors especially might not want to push into these new models and reforms. But I think my combination of business exposure, as well as years of medical practice, lets me be more effective and credible in front of the clinical audience.

    If I can say I've been there, I've lived that, and there is a more efficient way of doing something, I think physicians will be more likely to listen.

    Q: Who are some of the star performers you've seen excel in accountable care that potentially could offer tools and solutions for members looking to up their value-based care initiatives?

    Bonnette: Let's start with nursing home care. One of the most successful tactics is when an internist or geriatrician works with PAs or even pharmacists to manage the care of elderly folks in nursing care facilities. They can radically reduce complications for these patients and dramatically cut the number of times they need to be admitted to a hospital or get readmitted. I've seen these programs help reduce hospital readmissions by up to 70%.

    Another example for elderly folks is CareMore, which has been around for nearly 16 years and focuses on the sickest Medicare patients who are incredibly complex—and usually have 7 to 10 overlapping diagnoses. CareMore has improved outcomes and quality of life for these patients, in addition to reducing their cost of care by 35% to 40%.

    The role of post-acute providers under accountable care

    South Central Alaska Foundation's person-centric care model and Arnold Milstein's ambulatory ICU care navigation program are two other initatives that can be easily duplicated. I think implementing such "best-in-breed" models across the country could save the U.S. something like 10% to 20% in medical costs annually. 

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