Health reform: Story shows how rival systems work toward accountable care

We hear a lot about accountable care organizations.

What about “accountable care?”

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to

A lot of the reporting on ACOs (accountable care organizations) has focused on the effort to get them up and running in various forms under Medicare. One model, “Shared Savings,” got off to a bumpy start when hospitals and other health care providers recoiled at a clumsy and complicated proposed rule. That was recently revised to make it less risky and less cumbersome for potential participants. We should be hearing more about who has been chosen to take part in another form of ACOs, the “Pioneers,” in early- to mid-November.

But the reporting sometimes focuses so much on rules and regs that it leaves people confused about what accountable care – not just accountable care organizations – might really look like, or at least what the early steps toward creating accountable care looks like. That’s why I liked a recent story from Minnesota Public Radio, on how two rival health care systems have teamed up to try to do a better – and more cost-effective job. (The quotes here are from the Web version of Elizabeth Stawicki’s piece “Healthcare rivals’ partnership improves patient satisfaction, lowers costs.” The link will take you to the full audio version.)

Minnesota has moved further than much of the country toward integrated health systems, and the state has quite a few quality initiatives going on as well. The story looks how two rival nonprofit systems in the Twin Cities area, HealthPartners and Allina Hospitals and Clinics, have begun to break down some traditional barriers and practices and work together in an “accountable” way.

After a year, they saved about $6 million – “bending the cost curve” so health care costs rose just 3 percent, down from 8. Patient satisfaction scores rose. The systems didn’t disclose to Stawicki how much they had to invest to get the new programs started; the conventional wisdom (or perhaps the conventional optimism is a better term) is that savings will increase over time, making up for that initial spending.

Her report gave some very concrete – and easy to understand – examples about how the two systems came together to try to improve care in financially responsible ways. None of them are brand new – I’ve encountered or read about other hospitals and health care systems introducing similar care improvement and physician feedback initiatives. But that doesn’t mean they aren’t interesting, particularly in the context of rival health plans working together in what they call an ACO “learning lab. The two systems:

  • They shared data with doctors about their patterns of prescribing name brand versus generic drugs. The prescription rates for generic drugs rose and cut total medical costs by about $1 million.
  • They made available lower cost options to the emergency department by expanding urgent care.
  • Primary care clinics provided additional support to high-risk patients with chronic problems to prevent hospital admissions.

They also stopped elective induced labor before 39 weeks, cutting complications and C-sections.

So is any of this happening in your community? If so, there’s a story in it. And if not – well, there’s a story in that too.

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