1st Edition

Accountable The Baylor Scott & White Quality Alliance Accountable Care Journey

Edited By MD Couch Copyright 2016
    238 Pages 23 B/W Illustrations
    by Productivity Press

    240 Pages 23 B/W Illustrations
    by Productivity Press

    While many health care organizations need to improve health care quality and lower costs, most lack specific strategies and tactics for implementing these changes. Baylor Scott & White Health has established and continues to develop an accountable care organization (ACO) called the Baylor Scott & White Quality Alliance (BSWQA) to improve the quality of care and decrease health care costs through clinical integration.

    Accountable: The Baylor Scott & White Quality Alliance Accountable Care Journey tells the story of the BSWQA and its clinical network and payers who are committed to delivering accountable, value-based patient care. It describes the need for ACOs in today's health care environment and details the framework and requirements needed to establish one.

    The book provides readers with essential background information about accountable care, including the Triple Aim and population health management. It outlines the infrastructure and governance framework needed to establish a successful ACO and supplies real-world examples from the ACO owned by Baylor Scott & White Health, the largest not-for-profit health care system in Texas.

    The book explores the concept of accountability for all stakeholders in today’s complex care systems, as well as the role of personal and organizational accountability in managing patient populations. It also includes detailed outlines to guide you in developing your own accountable care organization—from step-by-step details of legal requirements to an outline of the role of payers in this model.

    Main Points for Chapter

    Why ACOs? How Can an Organization Produce Accountability?
    Main Points for Chapter
    The Accountable Care Organization
    What Does It Mean to Be Accountable?
    Accountability for Quality
    Accountability for Cost
    Accountability for Clinical Integration
    Accountable by Whom and to Whom?
    Accountable Care Structures

    Structure and Organization: Putting an Accountable Care Organization Together
    Main Points for Chapter
    Structure of Accountable Care Organizations
    Accountable Care Organizations: Legal Considerations
    Governance and Organization

    Patient Experience of Care
    Main Points for Chapter
    Responding to Consumerism through Accountable Care Organizations
    Activated Consumers
    Reference Pricing
    Wellness, Technology, and Self-Care
    Consumer Expectations about Access
    Retail Clinics and Access to Care
    Consumers Expect Patient-Centeredness
    STEEEP Care in Inpatient and Outpatient Settings
    Shared Savings and the Patient Experience of Care
    Role of Hospitals in Population Health
    Integration between Hospital Care and Ambulatory Care

    Population Health
    Main Points for Chapter
    Baylor Scott & White Quality Alliance Population Health Infrastructure
    Patient-Centered Medical Home
    BSWQA Specialists and Care Protocols Complete the Total Care Experience
    Care Coordination
    Transitional Care
    Data Analytics
    Behavioral Health
    Value-Based Contracting Driving Improved Quality and Reduced Costs through Population Health Management
    Optimizing the Medicare Shared Savings Program to Drive Value-Based Care
    Proactive Customer Engagement: Using a Wellness Visit Business Model to Drive Population Health
    Information Technology: Promoting Population Health
    Population Health: Summary

    Financing Accountable Care
    Main Points for Chapter
    Health Care Costs
    Improving Health Care Value by Reducing Waste
    Current and Future Role of Payers
    Financing Population Health
    Employer-Financed Insurance and Insurance Design





    Carl Couch, MD, MMM, FAAFP, is the President of the Baylor Scott & White Quality Alliance, a clinically integrated organization of 625 employed physicians, 1800 independent physicians, Baylor Scott & White Health (BSWH) hospitals, and other providers of care whose mission is to improve quality and reduce the overall cost of care for the patients and communities served by BSWH.

    Before coming to his current role, Dr. Couch served as Vice President of Health Care Improvement of Baylor Health Care System (BHCS), now part of Baylor Scott & White Health, from 2010 to 2011 and was the founding director and 13-year Chairman of the Board of HealthTexas Provider Network. He was also the founder of Family Medical Center at Garland, Texas and has been an active family physician for 40 years. Additionally, Dr. Couch was founder and executive director of ABC Baylor; Co-Chairman of the BSWH Best Care Committee; founder and Director of Baylor Health Care System’s Advanced Physician Leadership course; and Director of the Physician Champions.

    Dr. Couch's interests as a physician leader include physician group dynamics, large group practice organization and function, physician compensation, systematic quality improvement, ACO formation, and medical informatics. He has also done extensive work in redesigning the clinical delivery model to reduce "hassles," improve quality, and work with the Dallas-Fort Worth community of payers, providers, and purchasers to simplify the complexity of care delivery.

    Dr. Couch is a board-certified family physician and an AOA graduate of the University of Florida Medical School. He completed his clinical training at Parkland in Dallas and holds a Masters in Medical Management from Tulane University in New Orleans and is a Fellow of the American Academy of Family Physicians.

    "The transformation of the U.S. health care delivery system to one based upon value and accountability is one of the compelling stories of our time. To undertake this transformation requires building a culture of accountability. And that requires leadership. This compelling book tells the story of how an already renowned institution built an organization to deliver better care for the patients it serves. Others attempting this task will find this invaluable."
    —Joe Cunningham, MD, Managing Director, Santé Ventures

    "This is the definitive primer and ‘user’s guide’ for health care executives and operating leaders who are designing, developing, or deploying an ACO. It is equally valuable for industry stakeholders as they partner and collaborate with ACOs. Invaluable insights, strategies, and tactics from an industry pioneer that will enable you to move forward effectively and efficiently."
    —Michael Weintraub, President & CEO, Optum Analytics

    "This is a very complete, yet concise story of the Baylor Scott & White Health accountable care journey. This book is a must-read for any health care system leader or physician leader who is developing or serving as a leader in an accountable care organization."
    —Paul B. Convery, MD, MMM, Clinical Professor of Healthcare Leadership & Management, Naveen Jindal School of Management, University of Texas, Dallas; and Former Chief Medical Officer, Baylor Health Care System

    "In a time of consolidation and turmoil in health care, Couch and his colleagues provide a clear and concise game plan for bringing organizations together around real performance—improving outcomes and efficiency. This is a forward-looking, yet practical, book that touches on the full range of issues that come up in a typical day and a typical decade for emerging accountable care organizations. It is well-written, thoughtful, and credible—an important contribution."
    —Thomas H. Lee, MD, Chief Medical Officer, Press Ganey Associates, Inc.; and Professor, Harvard Medical School

    "Most large health care organizations today are re-imagining the delivery of and payment for health care services. The Baylor Scott & White Quality Alliance (BSWQA) has actually started the process and is demonstrating impressive preliminary results. Texas Health Care is proud that many of our physicians are affiliated members of the BSWQA."
    —Larry Tatum, MD, President & CEO, Texas Health Care, P.L.L.C.

    "Accountable is nothing less than a clarion call for accelerating the transformation from provider-centric volume to patient-centric value in health care. The description of BSWQA’s journey, which includes governance, care delivery innovations, process, staffing, and payment models creates a readable and engaging ‘ACO primer’ which is timely and unique. BSWQA’s story represents a rare, honest ‘look under the hood’ of what it takes to make an ACO and its tenets of population health actually happen—and in the near term. This book should be widely read for its leadership vision, practical perspective, and operational considerations applicable to every provider and delivery system. This ‘ACO parable in real life’ has lessons for even the most established medical group or health system."
    —Michael Parkinson, MD, MPH, FACPM, Senior Medical Director of Health & Productivity, UPMC Health Plan

    "Dr. Couch and his colleagues provide a valuable resource for anyone seeking to understand accountable care and population health. The story of the Baylor Scott & White Quality Alliance’s journey provides an excellent model with practical examples for others to learn from. This book is a must-read for anyone whose organization is seeking to achieve the Triple Aim."
    —Gary Yates, MD, President, Sentara Quality Care Network; President, Healthcare Performance Improvement, LLC; and Former Senior Vice President and Chief Medical Officer, Sentara Healthcare

    "It is increasingly difficult in health care to navigate a course between the competing interests of providing high-quality care for our community of patients and maintaining fiscal responsibility. Consumers must be able to afford quality medical care, and health systems must be able to provide it in a fiscally prudent manner. The Baylor Scott & White Quality Alliance is transforming its system and relationships with providers and setting a benchmark for other health systems to attain, including population health accountability and pay for performance. This book maps a pathway to successful implementation."
    —J. Lindsey Bradley, Jr., FACHE, President, Trinity Mother Frances Hospitals and Clinics

    "Dr. Couch and his team have upheld the profound Baylor Scott and White Health tradition of passionate leadership in Patient Care, Community Service, Education, and Research through this new book outlining responsible disruptive innovation to take us to Value-Based Care. With the foundation of the Hippocratic Oath to the work of the Institute of Medicine to STEEEP (safe, timely, effective, efficient, equitable, patient-centered care), they chart a comprehensive, practical and personal journey for all of us in leadership, and those we serve, to replicate and scale. The Health Employer Exchange members will be enlightened and inspired to adapt it throughout our nation."
    —Stephanie S. McCutcheon, Innovation/Transformation Advisor, Health Employer Exchange