1. What is Shared Accountability, and what are its goals?

Response: Shared Accountability is a strategy for providing the highest quality healthcare at sustainable rates. This will help us continue to fulfill our mission: providing excellent healthcare. 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 the population; 2) the best care for patients; and 3) affordable and sustainable costs.

2. Why is Intermountain pursuing a Shared Accountability strategy?

Response: Currently, healthcare in America is provided with 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.

3. Is Shared Accountability a response to healthcare reform legislation?

Response: No, not specifically. 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. And our search for solutions has been independent of healthcare reform efforts.

4. What will Shared Accountability require of patients?

Response: 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 get more involved in decisions about their treatment options so they fully understand the potential benefits, risks, and costs of different therapies.

5. How does Shared Accountability differ from the managed care movement of the 1990s?

Response: Shared Accountability differs in several important ways.
  • Responsibility. First, in the 1990s, HMOs were primarily responsible for managing the care of the plan members, whereas in 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 not just about managing costs and saving money; it also requires the achievement of quality and patient satisfaction standards.
  • 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.

6. How does Shared Accountability differ from the ACO concept?

Response: See the following table:

Shared Accountability Versus ACOs

Shared Accountability 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.

7. How will you accomplish the Shared Accountability goals?

Response: Primarily through quality improvement and evidence-based medicine. These efforts focus on providing the right care that is proven most effective for each patient. In the last 25 years, Intermountain has demonstrated that, in healthcare, higher quality care often costs less. That may sound counter-intuitive, but it makes sense that when care is provided in the right way, patients do better. We see fewer complications, fewer readmissions, and better health overall. So we're trying to take our quality improvement efforts to even higher levels and translate the cost-savings into lower insurance premiums.

We will also enhance our prevention, wellness, and care management programs. We'll seek to involve patients more in decisions about their treatment options. And we'll continue our focus on operating as efficiently as possible.

8. What safeguards are in place to ensure hospitals and physicians provide appropriate care?

Response: 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.

9. How are you addressing cost increases?

Response: 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 low 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.

10. How will Intermountain transition to Shared Accountability? What are the steps involved?

Response: Intermountain plans to position itself for a Shared Accountability environment over the next two to five years. The steps toward Shared Accountability include: 1) expansion of our quality improvement efforts, achieved through enhanced Clinical Programs and Clinical Services; 2) alignment of financial incentives for all involved in healthcare; 3) development of new SelectHealth products that embrace Shared Accountability principles, such as Medicare Advantage and Medicaid products; and 4) 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).

Intermountain is approaching Shared Accountability in a reasoned, methodical, and measured way that relies heavily on physician involvement and recommendations. This initiative will take time to develop. And that's okay.

11. Does Shared Accountability entail an expansion of Intermountain's Clinical Programs and Services?

Response: Yes. Shared Accountability entails an expansion of all quality improvement efforts at Intermountain, and many of these efforts take place under the auspices of our Clinical Programs and Services. 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.

12. Will you continue your support of community clinics, charity care, and other community benefits?

Response: 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.

13. Can other organizations follow a Shared Accountability approach also?

Response: Yes. Other organizations can also adopt this approach.

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