Accountable care organizations
For many health systems, the choices to be made about accountable care organizations are less about specific programs and more about a general direction toward physician integration and managing risk. Dale Maxwell, senior vice president and CFO for Albuquerque, NM–based Presbyterian Healthcare Services, said having the structures for risk and capitation are not new to them.
“We’re more comfortable at taking risks maybe than other healthcare systems because that’s how we have to make it in Albuquerque,” Maxwell said. PHS does have a health plan and puts the financial performance of its hospitals and providers at full risk for about $300 million per year. Even with that experience in managing risk, however, Maxwell said “the incentives at this point are not fully aligned with what we need.”
Jeff Sandene, CFO, health services division, for Sioux Falls, SD–based Sanford Health, agreed that his health system “can’t be the leading edge in the reimbursement side until something catches up.” Sanford is working with its primary care physicians to develop a new model to manage patient populations that may eventually come under the financial risk of the health system.
“We’re trying to revamp the whole primary care because we feel that that’s going to be our baseline for the chronic care disease, the medical home management within our clinic system for those folks versus having them come back to the hospital,” Sandene said. “But we have to figure out how to pay primary care physicians differently because right now they get paid for what they see and what they do.”