This document summarizes lessons learned from 59 pioneering hospitals transitioning to accountable care models. It finds that while individual components like health homes and data management scored highly for some hospitals, readiness requires strength in all areas. Top factors for readiness included risk-based payer contracts, clinical integration, and health IT infrastructure. Market factors like size and location mattered less. Successful implementation involved starting with high-need patients, engaging physicians, and focusing on culture change. Challenges included slow physician and payer adoption, while strategies that worked were piloting programs and maintaining momentum through incremental changes.

1. Measuring progress toward
accountable care: lessons from 59
pioneering hospitals
Keith J. Figlioli
SVP, Healthcare Informatics
Premier, Inc.
October 8, 2013

2. Will vs. Preparation
Photo credit: usab.com
“The key is not the will to win. Everybody has that.
It is the will to prepare to win that is important.”
~ Coach Bobby Knight, 1984 USA Men’s Olympic Basketball
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3. U.S. Healthcare Sector:
Three major transformations simultaneously
Care Model
Payment
Model
PAYMENT MODEL
End of CrossSubsidization
Shift to Voucher
Marketplace
Integrated vs. Fragmented
Personal Accountability
Assumption of Risk
Insurance exchanges
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Organization
Model
CARE MODEL
Primary Care/PCMH
Hospitalists / Hospitalbased Medicine
Behavioral Health
Chronic Disease Focus
Social Science Tools
Shift from sick care system
to health system
ORGANIZATION MODEL
End of Private
Practice Medicine
Consolidation of
Health Systems
Rise of Physician &
Clinical Leadership
Hospital
Health System
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4. And behaviors need to change
Protecting one’s
“turf”
All ideas proprietary
Closed systems
Little transparency,
no bias for sharing
Competition
between providers,
with others across
healthcare
Spotty collaboration
efforts
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Data hoarding
Avoiding
confrontation when
things aren’t
working
Few cross
continuum
partnerships
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5. Today’s discussion
A framework for assessing readiness
• Participants
• Methods
Important attributes for readiness
• What mattered
• What didn’t matter
What we can do about it
• Challenges
• Successful strategies
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6. Framework

7. Growing number of ACOs nationwide
252 Medicare ACOs
in 43 states
Over 430 Medicare and
Commercial ACOs
500 providers in CMS
Bundled Payment
initiative
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8. The Network Effect – Premier PACT Collaborative
29 markets | 23 systems | 100+ hospitals | 5,000+
MDs, 1.5M accountable care covered lives
86 markets | 67 systems | 300+ hospitals | 12,000+
MDs
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9. Assessing readiness
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10. The Bridge from FFS to Accountable Care
What are the
underpinning
building blocks?
Current
FFS
System
Accountable
Care
Accountable Care Core Components
People
Centered
Foundation
Health Home
High Value
Network
Population
Health Data
Management
ACO
Leadership
Payor
Partnerships
Foundational Philosophy: Triple Aim™
Measurement
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11. Readiness

12. Overall Assessment by Component**
Patient Centered
Foundation
100%
80%
Payor Partnership
60%
Health Home
40%
20%
0%
High Value
Network
ACO Leadership
Population Health
Data Management
Blue = Top Decile
Green = Median
Red = Bottom Decile
**Data from 59 assessments
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13. Variation Among Organizations with High Component Scores
Weighted Component Scores
Organization (in
order of high to low
overall weighted
score)
HH
HVN
PHDM
ACOL
PP
Organization 1
0.76
0.47
0.67
0.63
0.64
0.47
0.61
Organization 2
0.59
0.64
0.52
0.60
0.46
0.39
0.53
Organization 3
0.44
0.17
0.53
0.52
0.73
0.72
0.52
Organization 4
0.51
0.42
0.36
0.56
0.58
0.58
0.51
Organization 5
0.55
0.52
0.59
0.52
0.50
0.10
0.46
Organization 6
0.41
0.38
0.44
0.47
0.45
0.55
0.45
Organization 7
0.44
0.50
0.33
0.27
0.57
0.51
0.44
Organization 8
0.52
0.27
0.47
0.46
0.47
0.36
0.43
Organization 9
0.55
0.28
0.27
0.27
0.28
0.13
0.30
Organization 10
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PCF
Overall
Score
0.34
0.21
0.53
0.23
0.26
0.18
0.29
Scoring well in one
component does not
always translate to
readiness in all
components
Blue indicates
higher scores
Red indicates
lower scores
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14. Top 5 and Bottom 5 – Lessons from Comparisons
Factors That Differentiate Organizations with High ACO Readiness
1. Full or partial ownership of a health plan with pop health mgt capabilities
2. Existing collaboration with other health systems in the community
3. Existing risk-based contracts with payers including bundled payments
4. A sophisticated EHR and HIE implementation strategy across the continuum of care
5. Clinical integration across the continuum of care
6. Patient-centered medical home with employed or community providers
7. Positive relationships with primary care and specialty care providers in the market
8. Active governance structures that include physician leadership (e.g. PHOs)
Factors That Do NOT Differentiate
1. Market share
2. Number of employed physicians
3. Disproportion of the market with government financed health services
4. Financial strength (strong for the entire group)
5. Medicare spending level – low cost areas are not further along
6. High proportion of commercially insured patients
7. Already in active execution of a clinical integration strategy across the system
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15. Implications for future ACO development

16. White paper health systems
Fairview Health Services is a nonprofit healthcare
system based in Minneapolis with more than 50% of
its revenue under ACO payments.
AtlantiCare, in
Southeastern New
Jersey, is the region’s
largest healthcare
organization and largest
non-casino employer .
Presbyterian Healthcare Services
serves Albuquerque and rural New
Mexico with physician services at
more than 30 different locations.
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Memorial Healthcare
System is a public provider
of healthcare services to
South Florida. It is the 5th
largest public system in the
nation.
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.

17. Essential lessons learned
Managing populations
requires fundamental
health delivery change
Focus of primary
transformation:
Aligning clinical
w/payment
Physician leadership,
engagement pivotal in
ACO shift
Critical success factors
Care coordination
Executive leadership & governance support
Comprehensive & coordinated primary care
services, integrated IT
Pace of execution limited
by payer/physician
readiness for value-based
participation
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Market pressures create
opportunities for
mutually-beneficial
partnerships
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18. Challenges and policy implications
Challenges with physicians, local payers, infrastructure
investment, state/federal data regs slows execution
Payers should also support ACO participation in medical
home & bundled payment programs
Work needed with patient engagement, specialist and
post-acute care arrangements, and data exchange
Ideal pacing unclear:
• Slow implementation leaks savings to non-participating
payers
• Rapid implementation increases risk
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19. Successful implementation strategies
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20. Crawl, Walk, Run…But Start
Target programs for top 5% utilizers - Atlanticare
Begin to change organizational construct - Presbyterian
Embedded care managers - Fairview
Start with small populations – Memorial
ED navigators – Presbyterian
Culture, culture, culture – All systems
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21. Bench or Game
Photo credit: nbaarena.com
No one has to change. Survival is optional.
~ W. Edwards Deming
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22. Thank you…