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How accountable care organizations can succeed: One provider's lesson

Dean Health System essentially has been an accountable care organization for years. Several factors, including EHR interoperability, data analytics and charm school, drive savings.

BURLINGTON, Mass. -- Health care reform touts accountable care organizations -- collaborative groups of providers sharing patient data in interoperable systems -- as the best setup for improved care coordination and efficiency. To many it seems to be a new, if not radical concept. For Madison, Wis.-based Dean Health System, however, it has been the status quo for several years.

"We're across the chasm, looking back, at this point," Dr. Craig Samitt, president and CEO, told the audience at last week's Massachusetts Health Data Consortium's HIT11 conference.

Dean Health consists of more than 500 doctors in 60 facilities. In addition, it runs Dean Health Insurance, Wisconsin's largest health maintenance organization, and a pharmacy benefit management company, Navitus Health Solutions LLC. Lastly, it has partnered with a hospital, run by St. Louis-based SSM Health Care, since 1912.

Several years ago, Dean Health reached a crossroads, Samitt said. Half its provider business came from within, while half came from Medicare and other fee-for-service payers. "It was killing us trying to navigate through this schizophrenia," he said.

Rather than focus on the inefficiency of treating readmission and illness, Dean Health opted to focus on value through specialty services, laboratory testing and preventive medicine. This shift required several changes, Samitt said:

  • Dean Health aligned its strategic plan by scheduling at least three weekly meetings for the CEOs of the hospital, payer and health system.
  • Through data benchmarking -- based on internal and external guidelines and best practices -- Dean Health was able to "unbundle and understand the variance of care within the organization."
  • To that end, clinical data analytics and other technology have driven innovation in a way that Dean Health is beyond federal meaningful use criteria and aims to achieve optimal use, Samitt said. (All system affiliates have been using the same electronic health record software for several years.)
  • Contrary to the prevailing notion of the accountable care organization offering bundled payments to everyone involved in a patient's care, Dean Health found it needed to unbundle payments, giving the hospital, the primary physician and specialists their fair share. To do this, the organization has determined set formulas for unbundling payments.
  • Finally, Dean Health implemented a program that Samitt dubbed "charm school," in which young physicians shadow experienced ones to learn how to improve service and increase patient loyalty.

We're across the chasm, looking back, at this point.

Dr. Craig Samitt, president and CEO, Dean Health System

Overall, this shift has driven an emphasis on growth, efficiency, quality and service, to the extent that Dean Health's physicians eventually will be paid based on these factors rather than on patient volume, Samitt said.

Other strategies for "bending the cost curve" include favoring generic prescriptions; prescribing 90-day supplies of medications for chronic conditions; and improving treatment options. This last strategy has reduced the need for certain patients to undergo such procedures as joint replacements. The medication savings are measurable and substantial, Samitt said: A 1% increase in generic prescriptions, for example, saves Dean Health $1.6 million a year.

In a sense, Samitt concluded, accountable care organizations simply represent managed care all over again. "We should take the opportunity to do it right," he said.

Let us know what you think about the story; email Brian Eastwood, Site Editor.

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