Webinar: ACO partners must find 'shared ground'
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Marquette General is a rural healthcare organization located in the Upper Peninsula of Michigan. With a workforce of 2,600, it is the area’s largest employer, according to Graser. The 350-bed facility is also the only tertiary referral facility in the area, he added.
In thinking about what an ACO might entail, “we divided our successes into two basic kinds of strategies. The ACO is going to require that we form bonds and relationships with, in some cases, people who have been competitors in the past. We want to look at how to coalesce other stakeholders to join with us in an ACO model,” Graser said. “How is that going to be different in the future than it has been in the past?”
The second part, according to Graser, is “how do we change us as a large multi-specialty medical center into a lean, mean, fighting machine that’s going to be necessary to be successful under healthcare reform?”
In July, Marquette General formed a new business called Superior Health Partners as an umbrella organization specifically to contract with government. “If you think about it [an ACO] is a new contractual model for reimbursement, so we wanted to have a new identity to be able to have a corporate identity for Superior Health Partners to be the ACO for the Upper Peninsula of Michigan.”
According to a live poll during the webinar, 34 percent of responding listeners—the largest percentage of respondents—are in active discussions to investigate an ACO care model, while 32 percent, the second largest group, are in the “first activity” stage. “A lot of you are hearing about this for the first time and talking about it for the first time. That’s where I think the industry as a whole is,” stated Graser.
Initially, there isn’t going to be one model of an ACO, Graser predicted, but ACOs will largely be primary care-driven. “However, the primary care base probably doesn’t have the capitalization or the infrastructure that they need to be successful as an ACO," which is why partnerships are imperative, he opined.
Marquette General looked to how hospitals relate to one another in a spectrum and went with a philosophy of joint operation agreements so that hospitals can maintain their identity in a partnership. “This [allows] hospitals to keep their own identity, keep their own board of directors, keep their own name in the community. They keep their own balance sheet—all the debt stays with the hospital—and merge their income statements that allows us to work with insurance companies together, to bargain together,” Graser shared.
“Going forward, some of the hospitals here are owned by the counties so…with those, we’re going to have shared service agreements.” It’ll look more like a joint venture than an operating agreement, according to Graser.
The use of health IT will attract partnerships, Graser stated. “You’d be hard pressed to find a department in a hospital that doesn’t have an IT component to it, so it’s the most salient thing that’s out there.” For an ACO, a lot of data must be collected, and issues will need to resolved such as how do you prove the health of a population.
Payor partners will likely be a vital part of ACOs, Graser suggested. Blue Cross and Blue Shield of Michigan will be partnering with Marquette General for ACO purposes, he announced.
“What does success look like to us? For us, it is a regional culture of value and safety predicated on a close relationship with physicians and other hospitals,” Graser concluded. “We need to figure out shared ground to make this bonding work [so we can] be nimble enough to work on setting up an ACO.”
The webinar was hosted by the Healthcare Information & Management Systems Society and McKesson.