BOSTON – Beth Israel Deaconess Medical Center, community hospitals and their physicians have formed a newly designed accountable care organization that is a model for how an academic medical center can thrive in today’s complex health care environment.
In the newly designed Beth Israel Deaconess Care Organization, hospitals and independent physician groups will contract, share risk and build care management systems together, with the goal of providing the highest quality care in the most efficient way, both in and out of the hospital setting.
The boards of BIDMC and the Beth Israel Deaconess Physician Organization have voted to create the newly designed ACO, effective Jan. 1, 2013. In addition, BIDMC and BIDPO are jointly investing $12 million in resources annually in care management and infrastructure to improve the coordination of patient care among hospitals and physicians, as well as to increase the ability of caregivers to focus on population health management.
A new kind of alignment of hospitals and physicians was one of the first goals in BIDMC’s strategic direction articulated by President and CEO Kevin Tabb, MD, when he assumed leadership of the medical center one year ago. He said it was fundamental for success in the global payment environment that hospitals and physicians work closely together in a new way to transform how care is delivered and coordinated across the continuum.
“Many teaching hospitals espouse these goals but the pace of making them reality has been slow,” said Tabb. “We have worked to develop this new ACO structure, unique to Massachusetts, to directly respond to the needs of community hospitals and physicians. Working together, we are all focused, not only on transforming how high quality care is provided consistently and efficiently to patients and communities, but also on keeping people healthy and out of the hospital to begin with. This is the way of the future.”
The hospitals and physicians will work in 50-50 partnership within BIDCO, sharing governance, joint contracting, and risk. It is designed to accommodate community hospitals and physicians that are not owned or employed by BIDMC, and results in a restructuring of the current Beth Israel Deaconess Physician Organization to add hospital ownership for purposes of jointly contracting with payers in the future.
BIDCO will be jointly governed by the leadership of the medical center, the physicians’ organization, and the community hospitals.
Health care is increasingly moving away from the fee-for-service payment system to one based on global payments to care for a population of patients, with risks and rewards based on providers meeting certain quality metrics. Already, approximately 50 percent of BIDMC’s patients are covered under some form of global payment contract.
“Our ACO offers a new paradigm for academic medical centers, community hospitals and physicians working together for success in a global payment environment. The importance of shared governance and risk contracting in this model should not be underestimated,” said Stuart Rosenberg, MD, President and CEO of BIDPO and Harvard Medical Faculty Physicians at BIDMC. “While everyone talks about care being shifted from the academic medical centers to community settings – ‘right care, right place, right time’ – Beth Israel Deaconess Care Organization is a business structure that delivers on that promise in the right way.”
“As we were developing this model, it became clear that ‘one size does not fit all.’ Community hospitals and physicians have told us they were looking for a flexible model, and one that would be attractive enough to achieve the size and geographic diversity to be successful,” added Tabb.
BIDCO’s structure is designed to ensure:
- Hospitals and physician groups that join have the flexibility to remain as independent entities;
- The hospitals and physicians groups will act collectively with an equal role in governance of BIDCO, including strategic planning and decision making;
- The hospitals and physicians will collaboratively enter into fully aligned risk contracting, particularly important at the community level;
- The hospitals and physicians will make significant shared investment in care management and infrastructure.
Primary care practices are key to health care reform’s mandate to better manage care, and BIDCO will work with PCPs to transform care management, in part through the investment in resources of at least $12 million annually over the next five years in new infrastructure, technology and staff for clinical care delivery.
While much of the resources will be aimed at improving acute care, a significant proportion of BIDCO’s financial commitment will be to enhancing coordinated care in physician offices and ambulatory sites and in the transitions between acute and post-acute care.
“Over the past two years, BIDPO’s physicians crafted and began to implement comprehensive plans to establish a market leading care management program,” said BIDPO Medical Director Richard Parker, MD. BIDCO will continue and expand on elements that include:
- Increased direct care staff, particularly additional registered nurses, medical assistants and licensed practical nurses, to support team-based, patient-centered approaches to primary care. In this model, physicians, nurses, nutritionists, pharmacists, technicians, social workers, residents, fellow and others form an interdisciplinary team built around the needs of an individual patient;
- Expanded information technology resources to allow for seamless exchange of information and modernized systems;
- Enhanced home health services for high-risk Medicare patients to reduce avoidable readmissions and improve patient outcomes.
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide.
BIDMC has a network of community partners that includes Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Anna Jaques Hospital, Lawrence General Hospital, Commonwealth Hematology-Oncology, Beth Israel Deaconess HealthCare, Community Care Alliance, Atrius Health and Hebrew SeniorLife. BIDMC is also clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.
Beth Israel Deaconess Physicians Organization is physician contracting and care management organization with more than 1,600 physicians, including close to 350 primary care physicians throughout eastern Massachusetts. BIDPO was an early adopter of merging financial global budget accountability with the provision of care and is one of the 32 Pioneer ACOs certified nationally by the Centers for Medicare and Medicaid. For more information, visit www.bidpo.org.