Accountable: The Baylor Scott and White Quality Alliance Accountable Care Journey

George Mayzell
2016 Baylor University Medical Center Proceedings  
Alliance (BSWQA), the accountable care organization (ACO) owned by Baylor Scott and White Health, which is the largest not-for-profi t health care system in Texas. It is a great summary for someone who wants to understand the rationale behind accountability and wants to take a deep look at an organization that has operationalized many pieces of this journey. Dr. Couch clearly documents the planning and operational process as BSWQA continues to move toward value-based health care. Th is book
more » ... ines the term "accountable" and quantifi es and qualifi es it in reference to new health care delivery models and the transition from volume to value. It takes us into the population health arena, understanding the critical value of accountability for quality, cost, and outcomes as critical inputs into the population health transition. Dr. Couch details how the ACO fi ts into a population health-centric model and patientcentered medical home model. Th e emphasis is clearly on primary care; however, the book ensures that readers understand the importance of the specialist role in ACOs' long-term success. Accountable emphasizes the rearrangement of the six Institute of Medicine aims into a trademarked Baylor health program known as STEEEP. Th is stands for safe, timely, eff ective, effi cient, equitable, and patient-centered care delivery (p. xxix). Pointing out that our health care system has been constructed to serve providers and is now transitioning to serve patients, the book takes us through some of the underlying demographics and cost drivers that are leading us toward the need for "accountability" and the role that physicians must play. Chapter 3 addresses the organization of BSWQA and emphasizes what is, and is not, an ACO. It details the legal aspects of forming a clinically integrated network and an ACO. Of particular value are the tables on pages 52-58 and pages 64-69, which provide information on the legal complexities and safe harbors of ACOs and clinically integrated networks. Th ese userfriendly charts alone are worth exploring this book. Accountable also lays out the BSWQA committee structure (Table 3 .6), with detailed information on the fl ow of data and information through various subcommittees. Th ese include • Membership and standards • Best care/clinical integration • Compliance • Finance, contracting, and compensation • Population health information technology It notes the importance of data in managing "accountability"-including the diff erent reports that are necessary for managing physician outcomes as well as the . It also addresses issues of consumer expectations, access, and wellness and shares an overview of bonus distribution models in the context of a shared savings bonus system. Th e importance of transitional care, and care transition nursing, is emphasized. Th is process includes carefully identifying diff erent subsets of risk at the patient level, wherein high risk is the top 5%, rising risk is the next 15%, and low risk is the remaining 80%. Th e importance of identifying these populations and accurately assigning care processes and transitional care coaches is emphasized. Chapter 6 discusses the fi nancing of ACOs with an emphasis on the third part of the triple aim, which is reducing per capita costs. Discussing six forms of waste, i.e., non-valueadded care-failure of care delivery, failure of care coordination, overtreatment, administrative complexity, pricing failures, and fraud and abuse-it explains how ACOs fi t into this waste-and cost-reduction strategy. Overall, the book excels in discussing the journey from volume to value in the context of creating accountability at the physician and the delivery system level. Accountable is highly valuable for anybody on the ACO journey who wants to understand operational steps in constructing committee structures, addressing legal hurdles, and developing fi nancing and incentive programs.
doi:10.1080/08998280.2016.11929506 pmcid:PMC5023315 fatcat:as3ieowutbd2vgnfb257aqyqqm