Playbook for Accountable Care

Lessons for the Transition to Total Cost Accountability

Step-by-step examination of the process hospitals and health systems should take to finance the transition to a new payment model, assemble the accountable care delivery system, and reconfigure operations to transform care.

Executive Summary

Defining the transition path to accountable care delivery
For hospital and health system leaders on the transition path to accountable care, a significant management challenge is defining the steps to migrate from today’s fee-for-service incentives in a fragmented market to total cost accountability for a defined population of patients. Pursing incremental financial and clinical transformations to ensure the financial sustainability of the strategic path forward is critical to an organization’s success.

Accountable Care Staging Path

Financing the transition through creative funding, partnerships
Organizations face two challenges in financing the transition to accountable care: (1) assembling the capital base to invest in a new model of care and (2) realigning incentives to reward accountable care success. To build the capital base, hospital and health system leaders will likely consider a range of capital funding sources including grants, foundations, and retained earnings from improved operational efficiency. Organizational leaders should also be evaluating new contract terms or new partnerships with payers or employers to reward success of the new clinical model.

New physician relationships, IT capabilities and ambulatory network capacity key
After securing the necessary financing to support the transition to accountable care delivery, the next step is assembling the right mix of assets and relationships necessary to streamline the acute care enterprise and proactively manage care for populations across a comprehensive ambulatory care network.

With physician partnerships, the goal will be to build a high-performance network capable of accepting and sharing payment for services likely through extensive employment or clinical integration. Investments in IT will support improving clinical care through network interconnectivity, clinical knowledge management, patient self-management support as well as improving administrative infrastructure through performance management and population risk management. Organizations will also need to evaluate capacity across the comprehensive medical network by building out access points, care team and virtual connections between patients and providers.

Transforming clinical operations
To deliver on the quality and cost goals associated with accountable care, providers will need to focus four essential operational priorities:

  • Define and hardwire high-quality, low-cost clinical pathways
  • Engage patients at primary care to support ongoing chronic care management and preventive care delivery
  • Build strong referral relationships among aligned providers to improve coordination
  • Activate patients in ongoing self-management

Successfully implementing new care models in the transition to accountable care also requires educating and engaging staff and stakeholders in the priorities and on-the-ground impact of the transition to accountable care.

Access the full study to learn more
The Playbook for Accountable Care offers a detailed look at the steps hospitals and health systems should take to finance the transition to a new payment model, assemble the accountable care delivery system, and reconfigure operations to transform care.

After reading this study, members will:

  • Understand the defining characteristics of accountable care and accountable care organizations
  • Understand the critical components of the accountable care infrastructure and specific competencies that ACOs will need to have in order to be successful
  • Understand what changes accountable care will require of hospitals with respect to relationships with other providers in the health care value chain, clinical care models, and patient engagement

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