"We've had very good engagement [by physicians]. That's not to say the discussions aren't sometimes difficult or that we've standardized everything yet," he says.
Knight credits much of the physician integration into the ACO to the program's governance. The Quality Collaborative created a 13-member board of managers consisting of physician leaders from Palmetto Health Baptist, Palmetto Health Richland, and the University of South Carolina School of Medicine as well as representatives from Carolina Care and Three Rivers Medical Associates, PA.
The board uses information gathered by the finance and analytics departments, as well as their clinical knowledge, to look for ways to improve outcomes using best-practice approaches. Financial leaders will be pleased to know that while cost reduction isn't the primary objective of the Quality Collaborative, it remains a strong undercurrent. The board sets targets for costs and utilization measurements. Then, to encourage physician performance and accountability, clinical data is captured on each participating member's individual physician practice and compared to the established targets. To corral outliers, evidence-based guidelines are used so doctors can see the variance and home on areas to improve.
Palmetto Health spent the first year configuring the program and assessing the organization's target areas. It wasn't until just three months ago that a shared savings program—an essential ingredient for an ACO—was added.