Healthcare Reform and Accountable Care
Recognizing the new and ongoing challenges facing healthcare organizations, Navigant has developed a new approach to consulting. Our focus is on responding quickly to the needs of health systems, hospitals, and physician groups as they meet those challenges.
This new approach allows Navigant to leverage its comprehensive capabilities and knowledge to help clients deal with healthcare reform. Our capabilities blend strategy, operations and implementation for clients throughout the healthcare system, including the hospital, physician group and payer segments.
Healthcare Reform Perspective
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Accountable Care Organizations (ACO): The New Game
One of the most significant changes in healthcare reform is the establishment of Accountable Care Organizations (ACOs). Don Berwick, MD, administrator of the federal Centers for Medicare and Medicaid Services (CMS), outlined his concept of the ACO as having the "triple aim" of "better care for individuals, better health for populations and lower capital costs without any harm whatsoever to patients."
As ACOs take hold, healthcare organizations can adopt a two-pronged strategy to manage the situation. Using the classic “two curve” planning scenarios, healthcare organizations can (1) live with the change while also (2) managing the paradox.
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Live with the change. The first part of this strategy focuses on maximizing the number of “heads in beds” by leveraging the current environment as much as possible. Healthcare organizations can maintain their current successful strategic direction and tactics to drive reimbursement and volume, while banking resources for the future.
- Manage the paradox. The second part of this strategy focuses on creating an integrated care continuum by proactively exploring growth alternatives with associated upfront costs as measured in both dollars and management resources. Although this part of the strategy could negatively impact performance related to “live with the change,” healthcare organizations can position these steps as a way to deal with the emerging challenges involved with hospital/hospital and hospital/physician integration.
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Navigant’s ACO Service Delivery Framework:
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CASE STUDY:
Growth Modeling and an Integrated PHO
With expansion and growth into geographically distant facilities, a 3000-physician, 8-hospital, clinically integrated PHO (Physician Hospital Organization) turns to Navigant to determine the appropriate operating model to accommodate their growth. Navigant evaluated the operational capabilities of the health system considering scalability of the clinical programs and infrastructure. Navigant conducted market specific research including onsite interviews with physicians to evaluate the receptivity of the market (payers, consumers, and physicians) to the ARP Model. Based on these evaluations Navigant recommended an approach for the health system to enter into new markets and identified the appropriate modeling system to leverage the organization’s capabilities in the most cost effective manner.
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