Accountable Care Organizations and Physician Joint Ventures Jeffrey P. Harrison Chapter 9 “I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.” —from The Hippocratic Oath (modern version) Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale. 1 Learning Objectives Demonstrate an understanding of the interparty relationships associated with healthcare joint ventures and accountable care organizations. Understand some of the dynamics and controversies surrounding the concept of accountable care organizations as an alternative approach to the current marketplace. Demonstrate a basic understanding of the patient-centered medical home with attention to how it supports network-based delivery systems. Master the concept of physician–hospital alignment and health system integration including consumer, provider, and regulatory developments. Assess the emerging role of medical groups and hospital-owned group practices across the continuum of healthcare services. Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale. 2 Key Terms and Concepts Accountable care organization (ACO) Clinical integration Equity-based joint venture Hospitalist model Integrated physician model Medical foundation Patient-centered medical home (PCMH) Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale. 3 Introduction A positive relationship between hospitals and physicians is important to the success of the US healthcare system, because hospitals and physicians can be both collaborators and competitors. Many hospitals and healthcare systems have moved to various models of physician integration through which hospitals hope to capture market share and physicians seek financial security. After the Affordable Care Act (ACA) was passed in 2010, physician–hospital alignment became driven by another factor: cost control and quality outcomes in the accountable care era (Reiboldt 2013). Physicians work in a wide range of settings and serve in leadership positions that have significant responsibility for quality of care. Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale. 4 Clinical Integration What Is It? Coordination of patient care between hospitals and physicians across the healthcare continuum— e.g., an accountable care organization (ACO). Provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs. Clinical integration is necessary to delivering high-quality, affordable care in the current environment (Jacquin 2014). Clinical.