"Beyond that your premium is increased," says Ubbing, and all have the opportunity to appeal. "You have to lead from the top," she says, in selling the idea to employers in the community. "This starts from inside your hospital."
Creating an ACO, she says, would mean much more capital risk. Developing an ACO "depends on the breadth of the organization. We do not own a home care, hospice, or a nursing home. Consequently, the care coordination in our market has to be done with other entities."
But Fairfield has good partners, she says. The federally qualified health center for the area is on the hospital campus, and it does own a palliative care unit.
"We all realize that in healthcare reform, an unfunded mandate is the idea that we implement community case management. The penalties for not doing it are extreme."
She recognizes the hospital's leadership role, but bristles at what she calls an "unfunded mandate" from the federal government.
"We have to have a quarterback, which has to happen sooner rather than later," she says. "To do that we have to measure the quality of care our partners are providing, and we may have to narrow the field. The federal government expects the hospital to take the lead but it's an unfunded mandate."