Academic journal article Frontiers of Health Services Management

University Hospitals: Creating the Infrastructure for Quality and Value through Accountable Care

Academic journal article Frontiers of Health Services Management

University Hospitals: Creating the Infrastructure for Quality and Value through Accountable Care

Article excerpt

Background and Introduction

University Hospitals Health System Inc. (UH), in Cleveland, Ohio, is a large, academic, integrated delivery system composed of a sizable tertiary teaching hospital-University Hospitals Cleveland Medical Center, doing business as UH Case Medical Center (UHCMC)-multiple suburban hospitals, two critical access hospitals, and two large employed physician practices composed of approximately 1,400 providers. Leading up to 2010, UH undertook the building of two major hospitals, a community hospital, and a cancer hospital; installed outpatient hospital facilities in communities that had a need for medical services; expanded its physician network, especially its primary care physician network; implemented a new central scheduling and billing system; and worked to implement an electronic medical record system (EMR).

UH, like many hospitals and healthcare systems, has sought to anticipate the dramatic changes effected by the external environment. Among them are healthcare reform's increased focus on quality and outcomes, including incentives to keep patients out of hospital, and mounting pressures on reimbursement and costs. The Institute for Healthcare Improvement's Triple Aim of improving population health, improving each patient's care experience, and reducing or controlling the cost of care is a well-accepted path to enhancing our healthcare system and was part of many national discussions leading up to passage of the Affordable Care Act. Specifically, accountable care organizations (ACOs) were proposed as a tool by which healthcare providers, hospitals, and physicians could work together toward achieving the Triple Aim.

During UH's strategic planning sessions in 2009 and 2010, we identified value-the combination of quality and efficiency-to be a key driver of our future success. Ahead of the enactment of the Affordable Care Act, in early 2010 we chose to proceed with the formation of an ACO. We believed the ACO was a novel vehicle by which to ensure that our delivery of healthcare maximizes the value of the services we provide and that those services are provided in the most effective way for each patient.

Previously, UH had operated a managed care organization, but we divested it in 2005. Thus, no specific organizational framework existed with which to create an ACO. This lack of a framework was both a disadvantage and an advantage for UH's leadership team, but the overriding advantage was that it allowed UH to build the governance and organizational structure anew while bringing together a diverse group of executives to help lead these efforts. This team included leaders from finance; government affairs; human resources; information technology; legal; managed care; physician and hospital leaders; strategic planning; and the majority of the C-suite, including the chief executive officer.

We chose to focus our initial efforts on forming an employee ACO to address the rising costs of our self-insured health plan, which covers almost 24,000 employees and their family members. Because it was not formed as an outgrowth of a managed care organization, it was designed around patients, UH's employees, and the medical services provided by UH. The leadership team believed that, if structured correctly, the ACO could be scaled to meet future needs and additional ACOs. The organization also strongly believed that to be a leader in population health management would require us to have expertise in pediatric, adult, and geriatric population management. This understanding ultimately led us to apply to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program as a Medicare ACO and to CMS's Center for Medicare & Medicaid Innovation (Innovation Center) for a Health Care Innovation Award, which provided the foundation for a pediatric ACO (presented as a case study later in this article). We have since built on our earlier work to collaborate on commercial ACOs with large national insurers. …

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