Follow True North to St. Louis

This month, The Mayo Clinic Proceedings has published a section (free and open to the public) dedicated to ACO (accountable care organization) commentaries written by leaders from large health systems across the country, including Ballard, Ascension, Partners, Atlantic, and Methodist Le Bonheur.  There is one to which I would like to draw your attention.  It is by Robert Porter and Amanda Tosto, from SSM Health Care St Louis, entitled, "The SSM Health Care Approach to Achieving 'True North': Improving Health Care Quality While Reducing Costs."

My regular readers will not be surprised to see that what I like about this article is the emphasis on process improvement, patient-centeredness, and transparency shown by the authors, irrespective of the regulatory or institutional framework offered by the federal government.  You or I might not agree with everything set out, but we have to admire the thoughtfulness and commitment demonstrated.  Here are some pertinent excerpts:

SSM Health Care St Louis thoroughly investigated the opportunity to participate in the Medicare Shared Savings Program (MSSP) as an ACO and weighed components of the application to determine if this program was in the best interest of the organization and, ultimately, the people in the communities that we serve. 

SSM Health Care St Louis has determined that its path forward is to respond to the fundamental factors driving the health care industry in the context of the overall US economy, rather than conform to the requirements set forth by the MSSP. We have designed a deliberate path, True North, which synchronizes the economics of its transformation with the operational changes necessary to accomplish that transformation. SSM Health Care St Louis recognizes that transformation and change must occur, whether or not the political environment is conducive to the current efforts of the Centers for Medicare and Medicaid Services to establish a reformed health care system within the regulations outlined in the Patient Protection and Affordable Care Act.

Like many health care organizations, SSMSL has determined that the future of its mission, and of health care in this country, depends on creating a system capable of delivering dramatically greater value and eliminating the rampant behavioral, clinical, and administrative waste within the current system. Value is defined as achieving high-quality outcomes with the greatest efficiency/least cost over time and across the continuum. Achieving this requires a major philosophical, cultural, and operational shift from a focus on volume and the treatment of sick patients to a focus on the active engagement of individuals, with the support of health care resources, to manage their health.

The key elements in SSMSL’s version of True North are:
● Assembling the elements of the health care system around the patient as an integrated team.
● Aligning the incentives of all parties, including and especially the individual, around optimizing health and minimizing waste. This includes, ultimately, placing financial risk with those best equipped to manage that risk, the person and her/his physician and care team.
● Developing comprehensive tools to support information-managed care across time and across the continuum including:
OE Predictive modeling of health risk in the population being supported; OE Clinical decision support to ensure that health care professionals have the information and resources needed to make fully informed, evidence-based decisions OE Disease registries that provide real-time information regarding the interventions needed to optimize management of patients’ care and the level of their compliance with their individual health management plan;
● Statistical tools to study and understand variation in order to address unjustified variation and test improvements in care delivery processes;
● Business intelligence systems to extract and report real-time information to support performance management;
● A culture of transparency and clinician-led accountability to drive the organization toward the goal of superior value.