Mainehealth Accountable Care Organization

[ Music ] >> Working together so our communities are the healthiest in America. That's MaineHealth's vision. Yet today's health care model presents challenges to meet that goal. >> In the U.S. we have a really fragmented health care system. And that fragmentation leads to errors, it leads to duplicate of services. >> It's now widely recognized that our quality of care, compared to other industrialized nations is not what it should be. It is the most expensive care in the world, and we're not getting great results. As physicians, certainly, we've lost track of often times is the cost of care. It just never registered that that was a part of what we were doing. >> And we in the emergency department, since we have such short amount of time with people, we tend to do lots of tests and we tend to assume that when people show up, they want everything. As physicians, we understand very well that more care isn't better care, but many patients don't understand that. >> Hi Mr. Carron, I'm Dr. Bauman. >> Born out of the Affordable Care Act, Accountable Care Organizations or ACO's may be the solution to the underlying problem health systems face. How do you ensure quality while holding down cost? ACO's take on that question by bringing together a group of health care providers. They assume responsibility and accountability for managing the cost and quality of the continuum of care for their patients. >> The point of an ACO is to keep people healthy. We provide care of course when someone gets sick and needs it, but the point is to keep people out of the hospital and to make sure that we only provide services that are truly needed by the patient. [music] >> The traditional fee for service model of paying for health care encourages more services for more people. ACO's however, emphasize engaging the patient in decision making to achieve higher quality outcomes and increased satisfaction. The MaineHealth ACO includes four strategic elements: an emphasis on primary care, strong care coordination, a robust information platform and transparency around the data gathered. To tackle the extensive data collection necessary for success, MaineHealth joined with Eastern Maine Healthcare Systems, Dartmouth-Hitchcock Healthcare System and Dartmouth College, to create the Northern New England Accountable Care Collaborative or NNEACC. >> We couldn't each of us, do it on our own, so we pooled resources in order to start a company that's going to provide us with integrated information from our medical records and from claims and billing data, to provide us with a much more complete picture of patient health than we would otherwise have. >> We've taken the data, now we've created information, information that's important about the clinical risk or the financial risk or the experiential risk of the individual and then we have to present that through an application so that the frontline care delivery folks, care coordinators and primary care physicians can access that information in a way which is actionable and can work in the workflow. >> So using the NNEACC program and toolset, we'll be able to look at our population of patients for whom we're accountable, segment them according to what they need and make sure we're addressing their healthcare needs, their gaps in care or maybe even doing some predictive modeling to understand who is at risk for an adverse health outcome or for incurring a lot of medical expense that if we were to intervene much earlier, we would be able to avert. [music] >> The data offers a powerful tool for caregivers and administrators. By looking across the MaineHealth System, groups can learn from each other, and identify care processes to replicate and identify areas for improvement. >> Our system is a bit diverse, and the advantage of that is we can really look to various parts of the system to find out what they're doing very well. >> How do we compare to each other? Does someone do a really good job treating diabetics that other people can learn from? [music] >> Every physician feels that they are working hard, doing the right thing and they're above average. But we know that that's not possible. And then you quickly realize that half the people are below average, and half the people are above average. You know, I'm not interested in being the bottom half of anything. And so when that transparency comes out, it's a big driver for us to improve, and that's great news for patients. >> Patients benefit from interacting with caregivers who have the complete picture of their care and the needs. The ACO model emphasizes quality and patient satisfaction. It's designed to give caregivers and patients the time and the information they need to develop care plans together. >> We want to engage the patients who have, for example, back pain, and talk openly over a period of time, about the treatment options they have. Sometimes that treatment option means no surgery. >> To have the opportunity to you know, dialog with patients and say, "Well, what do you really want, you know, from this visit?" And "I see that you had three CAT scans in the past two years. Let's talk about different ways we could try to attack this." >> So a lot more conversations around what patient's individual goals are, having patients at the center of directing what it is that matters to them. >> The MaineHealth ACO is unique and reflects the diverse population we serve. Unlike other ACO's across the country, it weaves together both independent and employed positions and spans rural and urban centers. >> Rural health care systems need to be as sensitive to and actively involved in ACO's as large organizations, that this is important for people in small communities and or businesses in small communities to expect the same sort of cutting edge delivery of care. >> ACO's have the potential for great success. To bring about the see change our country's health care system needs. And from its start, MaineHealth has been building a foundation for that change. >> A lot of the components of ACO, the PHO had been doing for many years, so certainly the care management and the care transitions work, doing population health management through the clinical improvement registry, were all core pieces of our work. But I think in the ACO's structure, we've been able to really focus that work and that framework has allowed us to propel that work forward. >> This is still a period of innovation, experimentation, and there isn't a clear prescription for success. How to deliver high quality care, better care than we do today, within a budget is the real challenge, but again, I do think that we've done a lot over the last 15 years to prepare ourselves to meet that challenge. It's something that an organization with our mission, with the vision that we've always expressed for MaineHealth simply needs to do. [music] >> From a patient's perspective, what they'll see is seamless transitions from setting to setting. They will feel that there's a care team that's wrapped around them and has a very intentional and deliberate plan of care for them. [music] >> MaineHealth's ACO is one of the biggest ACO's nationally. When you think about who's really leading health reform across the nation, we can stand up. [ Music ]