"Maintaining the status quo in American healthcare is not an option," says Joe Mott, Vice President for Healthcare Transformation, who is in charge of developing Intermountain's Shared Accountability approach. "We're taking action now to ensure Intermountain and the caregivers associated with us will always be able to fulfill our mission of providing excellent care, even as the healthcare environment changes."

Greg Poulsen, Intermountain's Senior Vice President and Chief Strategy Officer, says a number of different trends are driving changes in how care is delivered:

  • Aging Baby-Boomers are becoming eligible for Medicare in growing numbers every day, placing increasing strain on the financial solvency of this federal insurance program.
  • Obesity rates continue to rise in Utah and the nation, creating spikes in the incidence of many health problems, such as diabetes, cardiovascular disease, high blood pressure, and stress on joints.
  • Medical technology and new therapies continue to proliferate but often with little evidence of the comparative effectiveness and risks of new treatments.
  • Those who ultimately pay for healthcare government, businesses, patients, and consumers in general are reaching the limits of their ability to pay for healthcare.

In 2014, Intermountain will continue to develop its Shared Accountability strategy, which will help patients, physicians, and employees achieve higher quality care while slowing the rise in costs.

Greg says these trends will continue regardless of how the legal challenges to the PPACA federal healthcare reform legislation are resolved-and regardless of politics. "No matter where one sits on the political spectrum, just about everyone agrees the problems facing healthcare are huge and urgently need to be addressed," he says.

Most options for dealing with these challenges come down to some form of rationing of care-but not at Intermountain.

"At Intermountain, we have a better approach to addressing these problems," says Joe. "Shared Accountability offers a way forward that offers an alternative to such rationing techniques as restricted benefits, exclusionary eligibility requirements, service delays, or exorbitant pricing. Shared Accountability preserves the best of American healthcare while addressing the problems of variable quality, access barriers, and runaway costs in a responsible way."

What is Shared Accountability?

Simply defined, Shared Accountability is an overarching strategy or approach, based on quality improvement, to deliver the highest quality patient care, optimize the health of those we serve, and manage costs. "It's about better health at a lower cost," says Joe.

For the last 25 years, Intermountain has demonstrated that in healthcare, higher quality often costs less because patients have better medical outcomes and tend to experience fewer complications and readmissions. Shared Accountability is based on the idea that everyone involved in healthcare has a role to play in achieving better health: hospitals, physicians, patients, and payers.

The initiative offers a way for Intermountain to collaboratively address healthcare challenges in a thoughtful and proactive way that preserves what's best in our healthcare system.

Shared Accountability has three basic goals

  • Quality. Provide the most effective, highest quality care (for patients).
  • Prevention. Promote better health and wellness (for the population we serve).
  • Cost management. Keep cost increases to a lower, more sustainable level (for patients and other payers). Over the next five years, we expect to reduce the rate of cost increases to a level near the general inflation rate.

How are we developing Shared Accountability?

"Think of Shared Accountability as an umbrella," says Joe. "Numerous programs and teams are being developed to fit within the context of our overall approach."

Physician Leadership

Physicians are among the leaders developing Shared Accountability: both Medical Group physicians and independent affiliated physicians, as well as clinicians representing our Clinical Programs and Services. With physician involvement, Shared Accountability programs will continue to be developed in 2014 and beyond.

One very important Shared Accountability project is represented in Intermountain's Physician Engagement Board Goal. Among other things, the goal calls for the creation of a program to inform physicians about Shared Accountability, listen to them, and engage them in its development. The goal also calls for research to determine baseline levels of physician awareness and understanding of the initiative.

Areas of focus

Intermountain created a Shared Accountability Work Group with Joe at the helm. Together with the Work Group, three associated teams Redesigning Care, Flow of Funds, and Patient Engagement-created a plan for developing Shared Accountability over the next five years. During 2014 and beyond, key areas of focus will be addressed. These areas represent major topics identified as being essential to Shared Accountability: Finance; Measurement; Outreach/Continuum of Care; Care Delivery and Management; Patient Engagement; Clinical Education; Network Development; Information Systems; Communication and Marketing; SelectHealth Products; Legal; Human Resources; and Compliance. Many of these topical areas also have working teams focusing on specific areas.

These areas of focus and their associated working teams are led by and comprised of existing Intermountain teams and leaders. The work has been organized this way for two reasons: 1) this approach avoids creating new teams and structure; and 2) it embeds this work into the day-to-day operations of the system.

Among the leaders developing Shared Accountability are physicians (both Medical Group physicians and independent affiliated physicians) and individuals representing our Clinical Programs and Services.

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