“There are 1,400 home care agencies in the Metroplex,” he says. “We use about 400–500 of those. That won’t work, as we see it, in a continuum where quality outcomes will be critical. You can’t have that much variation.”
Though they have no immediate reimbursement options under an ACO framework, that doesn’t mean the two systems aren’t expecting to have them in the near future, and they want to be ready. Both are participants in Premier’s ACO Collaboratives, pilot programs initiated by the membership-owned group purchasing organization.
And, Hawthorne says, the THR/Methodist agreement is not the last such partnership, even though
ACO opportunities are only in the formative stages.
Both organizations will contribute senior strategy and finance representatives toward committees that will work together on the vision of the partnership. Hawthorne and Methodist President and CEO Stephen L. Mansfield will also join those conversations monthly.
“We’ll begin to assess and analyze whether we are on some tracks that will create benefit,” he says.
As they see the structures of accountable care unfold, they’ll consider whether and how to share data or certain elements of patient outcomes, and will have to work on creating certain “firewalls” so that proprietary information won’t be shared.
“We don’t have a formal plan until we get good feedback from our folks on what the opportunity might be,” Hawthorne says. “It’s kind of like opening a model airplane kit. As we look at the pieces, we’ll begin to formulate and put them together as we see the need. In a year, we will have designed something.”
Each will continue to do its own negotiations with private payers, and Hawthorne predicts that within a year the systems will know more about what payers are thinking concerning accountable care payment structures, which will allow the two systems to work in a more aligned way to create products. Hawthorne is hopeful for more deals like the one it signed with BlueCross BlueShield of Texas in 2010 that creates pay-for-performance incentives that “have great value from both parties being engaged in improving outcomes.” They’ll push that conversation with payers in negotiations, he says.
“You will see similar alignments across the country of like-minded and like-missioned organizations going forward. For us, it’s preparation for what we may begin to see in 2014 as health reform issues begin to take off,” he says. “We think of where the puck is going rather than where it is. You’ll see THR doing similar cooperative arrangements with others in the Metroplex.”
He does not expect that such arrangements will face antitrust scrutiny, either.
“We’re walking into some new waters, but we’re not uncomfortable because we’re not dividing territory or doing some other yellow- or red-flag things that would draw their attention.”