This analysis from HealthLeaders Media describes four hospital and health system models of improved health care delivery that could be the basis for forming and implementing  accountable care organizations.  The models profiled are Monarch HealthCare, Franciscan Alliance/St. Francis Hospital and Health Systems, Nebraska Accountable Care Alliance, and Palmetto Health Quality Collaborative.

The analysis notes:  “If ACOs are to take root, providers must assess and build capabili- ties in specific areas of coordinated care, including patient-centered medical home and population health management. That necessarily begs for necessary improvements to the infrastructure, including advancement of the electronic medical record and data mining capabilities, as well as building the primary care base of physicians and senior-level primary care nurses.”

One Senior VP puts it bluntly: “The imperative is not going away. We absolutely can no longer tolerate the substandard quality of care that is produced in our healthcare….unless the first three of…four Ps, payers, providers and patients, come together and figure out some way to address the imperatives to improve quality and reduce cost, the fourth P, the politicians, will step in and do it for us and it won’t be pretty.”

Some of these models are much more focused on improvements in in-patient quality than either the Medicare Physician Group Practice Demonstration or the proposed rule for Medicare Shared Savings Program ACOs.  For example, MonarchCare’s draft ACO quality scorecard is composed of 70% physician quality measures and 30% hospital quality measures, while only 2 of the 65 quality measures to be used in the Medicare Shared Savings ACO are hospital quality measures.

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