CEO Interview Series: The Fundamental Challenges of an ACO
May 15, 2011
Posted by chcablogadmin in : ACO Update
Alan Goldbloom, M.D., President and CEO, Children’s Hospitals and Clinics of Minnesota, presents the distinct challenge for children’s hospitals in creating an ACO model. Jacqueline Kueser, CHCA Vice President, recently interviewed Alan as part of a series of CEO interviews about post reform strategies. As a former pediatrician and hospital administrator in Canada, his experience on both sides of the universal, government-funded health care debate brings unique perspective. Read or re-read Alan’s blog posted last year with his insightful comparison of the two national systems. — JR
Interview with Alan Goldbloom, M.D., President and CEO, Children’s Hospitals and Clinics of Minnesota
Alan Goldbloom, M.D.
“Accountable care” is built on the premise of assuming responsibility for broad-based care ranging from primary to tertiary. Children’s hospitals have a fundamental problem adapting to this model of care. The majority of freestanding children’s hospitals function as tertiary, regional providers, and not necessarily as integrated delivery systems. With increasing numbers of beds (often 30 – 50%) devoted to intensive care, and with admissions coming from all over a region, we may have little or no involvement in their primary, long-term care. Moreover, many of the outpatients who come for specialty care may be seen only for a single episode of illness, with subsequent care provided by primary care practitioners dispersed across the hospital’s catchment area. The prospect of having formal relationships with all referring physicians in a region is difficult to imagine, even though such relationships are the underpinning of many payment reform models. This is in sharp contrast to some of the large adult integrated delivery networks who own regional medical centers, smaller outlying hospitals and primary care practices.
At Children’s of Minnesota, we are implementing three strategies to help us move closer to an accountable care framework:
1.) Physician alignment—we are forming a Clinically Integrated Network (CIN) with primary care and specialty practices throughout the Twin Cities. The CIN will replace our current Physician Hospital Organization, will set quality and performance standards, will be connected by information technology, and will allow for collective contracting arrangements with payors (including bundled payments). We have also begun to purchase some smaller primary care practices, and are developing Professional Services Agreements with others, whereby we would purchase their assets, contract on their behalf, and contract with the physicians to provide the care. We have learned in our region that one size cannot fit all. Therefore, the goal is to offer a variety of arrangements that would ultimately advance care integration in the metro area, and establish a framework for accountable care.
We have learned in our region that one size cannot fit all. Therefore, the goal is to offer a variety of arrangements that would ultimately advance care integration in the metro area, and establish a framework for accountable care. — Alan Goldbloom, M.D.
2.) Hospital alignment—we are in discussions with regional hospitals to help staff their pediatric units, provide subspecialty support, and share pediatric protocols and standards. This would allow us to leverage our brand more broadly in a market that is highly competitive for tertiary/quaternary pediatric care; by enhancing the pediatric care in these regional hospitals, we would enhance and grow the relationships that ultimate result in our hospital being their first choice for more complex services.
3.) Maternal-fetal medicine—we are creating partnerships for joint mother/baby facilities to enable the neonates and their families to take advantage of services on the children’s hospital campus. At our Minneapolis campus, this will involve a new Mother-Baby Pavilion built in partnership with the largest adult system in the state (Allina), who would move all of their obstetrics from their flagship hospital, Abbott Northwestern, onto the Children’s campus. In addition to providing a home base for our joint fetal diagnostics and intervention program, it will be both a normal and high-risk maternity center with 4,000 deliveries per year. Moreover, it will be adjacent to our NICU so the sickest newborns will no longer be separated from their mothers. The second component of the program is to extend the partnership into the other adult hospitals in the Allina network, thereby developing a single standard of neonatal care.
Our future efforts will need to focus on ambulatory networks and data exchange with other physician and hospital providers. We will also evaluate the feasibility of owning a managed care plan to enable us to assume more risk. The concept of assuming total risk is not foreign to me, since I worked previously (in Toronto) in a system where we had a global budget for the hospital. We knew on January 1 each year what our revenue would be for the next 12 months, and had to meet our mandate to provide care. I actually don’t recall it was any more challenging than trying to deal with the ongoing uncertainties of Medicaid funding in the U.S. today, especially now that we are in an era when most states are facing budget deficits. I am therefore open to the option of having both the risk and the responsibility for care, with the qualifier that we need to carefully model such a plan around the reality of decreased resources in the future.
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