Building Upon Core Values to Pursue an Accountable Care Strategy
Client/Profile
PHO in Midwest affiliated with a 300-bed health system
Challenge/Situation
To develop a strategic plan that delivers value to the multiple constituents of the 750-physician member PHO. The plan needed to balance initiatives to address immediate contracting efforts and finances, while concurrently positioning the organization with the resources to implement innovative contracting strategies in the future.
Process
Veralon developed a strategic assessment of the PHO, based on data analyses and a series of interviews with key hospital, physician, and PHO leadership. This assessment was reviewed at an initial retreat facilitated by Veralon, we provided education and context on the local market, trends affecting PHOs and the opportunities related to health reform, including ACOs.
Results
We collaboratively identified a vision for the PHO as a local physician-driven model of care, with a single consistent approach to how care is provided, negotiating with payers to be rewarded for the value it creates. Retreat participants agreed that an ACO opportunity fit with this vision and might be a viable strategy to pursue.
In a subsequent retreat, Veralon presented a full assessment of the ACO opportunity, including:
- The potential size and savings of the ACO
- The PHO’s capabilities to operate the ACO
- An estimate of additional and ongoing staffing costs
- A schedule of expected investment and return
- A strategic vision that combined ongoing contracting efforts with ACO development.
Participants agreed that an ACO strategy should be pursued. Physician leadership is excited about this opportunity and is leading an effort to educate peers. The PHO is continuing with detailed planning and is taking the required steps to position itself for ACO contracting.