8 Accountable Care Organizations Worth Closer Look
ACOs break new ground in healthcare as cost pressures mount for providers.
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Sean Gleeson, MD, medical director of Partners for Kids, says the key to the success of Partner's ACO is understanding the cost and quality drivers of its population. "We can't do everything at once, and so understanding the most important things to do first is critical," he said.
Partners For Kids is responsible for over 300,000 children in central and southeastern Ohio who are part of the Medicaid program. The ACO is jointly owned by Nationwide Children's Hospital and by 800 physicians.
Appropriate analytics allows the organization to understand what clinical issues drive the outcomes, what common characteristics in its patient population clinicians need to address, and which providers can do the best job, said Gleeson.
Gleeson said Partners For Kids was created to remove the burden of overhead created by the normal tension between providers and payers.
Partners receives a capitated payment from the Medicaid Managed Care health plans. There's a contractual arrangement between the ACO and the plans that is not officially sponsored by any of the regulatory initiatives at the federal level.
Rather than a one-size-fits-all case management/care coordination program, the ACO targets specific populations using the clinical staff already serving those patients. A shared medical record helps eliminate duplication of care. The EMR from Epic is a combined record across all the inpatient and outpatient sites within Nationwide Children's Hospital, and accessible to providers outside of its system when they share responsibility for the children. When care is provided within the Nationwide Children's network, doctors get access to a deeper level of data available through the electronic medical record.