What is Shared Accountability, and what are its goals?
Shared Accountability is Intermountain’s approach for providing the highest quality healthcare at more affordable, sustainable rates. This will help us continue to fulfill our mission and vision. We envision a better future for healthcare than others might predict based on the current challenges, and Shared Accountability is a path forward to that future. Shared Accountability has three goals: 1) the best health for those we serve; 2) the best care for patients; and 3) affordable and sustainable costs.
Why is Intermountain pursuing a Shared Accountability strategy?
Currently, healthcare in America has variable quality, barriers to access, and costs that are rising at unsustainably high rates. Many of the solutions being proposed around the country entail arbitrary cuts in payment that would put patient access and quality of care in even greater jeopardy. Yet the experience of Intermountain and some other leading healthcare organizations shows there is a better way to provide care, based on medical best practices, that can address the challenges effectively. We feel we have an obligation to the community to offer an approach that will continually improve quality while managing the cost of care.
This is an effort we’re undertaking proactively in view of the trends we see, not in reaction to any particular factor or event. We can’t envision any future in which higher-quality care provided as affordably as possible will not be a successful strategy.
Is Shared Accountability a response to healthcare reform legislation?
No, not specifically. Our search for solutions has been independent of healthcare reform efforts. The underlying problems in American healthcare are inconsistent clinical quality, inconsistent access to care, and costs that are increasing at unsustainably high rates, historically about two to three times the general inflation rate. Leaders and health policy experts representing the entire political spectrum recognize these problems. Intermountain and other healthcare organizations believe we need to do what we can to address these issues.
What does Shared Accountability require of patients?
Patients are being encouraged to take advantage of prevention and wellness programs aimed at improving their health. Those with chronic diseases like diabetes are encouraged to take advantage of Intermountain’s care management programs. We’re also encouraging patients to use provided tools to get more involved in decisions about their own care so they fully understand the potential benefits, risks, and costs of different options.
How does Shared Accountability differ from the managed care movement of the 1990s?
Shared Accountability differs in several important ways.
How does Shared Accountability differ from the ACO concept?
- Responsibility. First, in the 1990s, HMOs were primarily responsible for managing the care of the plan members/patients, whereas with Shared Accountability, the responsibility is shared among the caregivers, the health plan, and the patients themselves.
- Quality and patient satisfaction standards. Second, quality and patient satisfaction measures are much more extensive, sophisticated, and transparent today compared to 15 or 20 years ago. Shared Accountability is about achieving quality and patient satisfaction standards, as well as managing costs and saving money.
- Financial incentives. Third, under managed care, the financial incentives typically were not effectively aligned, and most physicians and hospitals continued to be paid only on a fee-for-service basis. Shared Accountability seeks to align the financial incentives of all parties more effectively, so that the outcome of better health is rewarded rather than just a high volume of procedures
See the following table:
Shared Accountability Versus ACOs
||Accountable Care Organization (ACO)
|Shared Accountability involves participation from all key stakeholders (patients, community, payers, physicians, and hospitals).
||Accountability is essentially one-way: The provider is responsible for cost/quality for their defined population.
|Shared Accountability is defined by Intermountain, not CMS. All patients will benefit, not just Medicare patients.
||ACO is defined by the federal Centers for Medicare and Medicaid Services (CMS). Organizations apply for certification as Medicare ACOs.
|Patient engagement is a function of benefit design (how care is paid for) as well as processes and tools for proactive engagement (such as wellness and care management programs).
||ACO regulations say little about patient engagement, given that responsibility lies specifically with the provider.
How will we accomplish our Shared Accountability goals?
We use three key strategies to achieve these goals:
- Redesigning care. Intermountain uses evidence-based medicine—treatments that have been proven effective—to determine what care is helpful and needed for each patient. We work to consistently deliver the right care, in the right setting, at the right time, by the right providers. We avoid under-treatment, over-treatment, and medical errors.
- Engaging patients. We understand the care of a patient involves care of the whole person—which includes mental, emotional and physical health, as well as lifestyle. We involve patients in wellness, prevention, and decisions about their care.
- Aligning financial incentives. Everyone benefits from high-quality, high-value care. We need a payment system that rewards hospitals and doctors for providing the right care rather than just more care. We also continue our traditional focus on efficiency, which helps us keep costs low.
What safeguards are in place to ensure hospitals and physicians provide appropriate care?
The safeguards include: 1) numerous clinical quality standards and transparency as to outcomes data; and 2) patient satisfaction surveys. Shared Accountability improves adherence to medical best practices and a wide range of clinical quality standards. Quality and patient satisfaction are continually measured.
How are we making care more affordable?
We’re addressing costs in three major ways: 1) reducing the need for care by helping patients stay healthy; 2) improving clinical quality so that our care processes provide the right care for each patient; and 3) improving operational effectiveness and efficiency so that unit costs (e.g., the cost of an X-ray) are as affordable as possible.
This is an effort that will affect all areas of our operations and will involve improving our teamwork, coordination, use of technology. Everything. We expect savings will come from all three methods.
How is Intermountain transitioning toward an environment based on Shared Accountability concepts? What are the steps involved?
Intermountain is positioning itself for a Shared Accountability environment between now and 2016 (and beyond). The steps toward Shared Accountability include: 1) expansion of our quality improvement efforts, achieved through enhanced Clinical Programs and Services; 2) alignment of financial incentives for all involved in healthcare; 3) an enhanced emphasis on engaging patients in the care they receive, with a greater focus on wellness, prevention, compliance with physician treatment orders, and care management (especially for chronic diseases such as diabetes); and 4) development of new SelectHealth products that embrace Shared Accountability principles.
Intermountain is approaching Shared Accountability in a reasoned, methodical, and measured way that relies heavily on physician involvement and recommendations.
Does Shared Accountability include an expansion of Intermountain’s Clinical Programs and Services?
Yes, and such expansions are based on the judgment of the Clinical Program and Clinical Services leadership. As leaders evaluate the needs and opportunities, they identify areas in which expansions will be helpful. Intermountain has eight Clinical Programs: Cardiovascular; Oncology; Women and Newborns; Primary Care; Intensive Medicine; Surgical Services; Pediatric Specialties; and Behavioral Health. We also have Clinical Services such as Imaging, Lab, and Patient Safety. These programs and services are supported by electronic data and decision-support tools.
Will you continue your support of community clinics, charity care, and other community benefits?
Yes, our commitment to providing these community benefits remains strong. In fact, the role of community clinics and some other supporting services may grow in importance as we seek to promote health and deliver care in the most effective settings.