Beth Israel Deaconess Goes ACO; What Does That Mean?

Does “ACO” mean anything to you yet? Well if you want to do more than nod and smile the next time you’re around a lot of doctors, read the next couple of paragraphs.

Hospitals that plan to stay in business in Massachusetts are either creating or joining Accountable Care Organizations (ACOs). Today we have a new one of these large “all care under one umbrella” groups: The Beth Israel Deaconess Care Organization (BIDCO) includes the hospital, its physicians’ group and two affiliated hospitals. BIDCO is in talks with Cambridge Health Alliance, Signature Healthcare in Brockton and a few other organizations about joining.

Dr. Kevin Tabb, who runs the hospital (Beth Israel Deaconess Medical Center), says ACOs offer a new and better way to deliver and pay for care.

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center and co-chair of the new BIDCO

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center and co-chair of the new BIDCO

“For a very long time,” says Tabb, “we’ve taken care of sick patients, doing a good job while they’re here and not thinking about them a lot after they leave the hospital. That felt like a broken model.”

Now, says Tabb, “we’ll think about patients not only when they’re here at the hospital, but after they leave,” and when they are well. Why haven’t doctors and hospitals done this in the past? Tabb offers two reasons: Doctors and hospitals haven’t had the structure to do this and they weren’t paid for keeping people well. Thus the new world, built around the structure of an ACO and financed by a global payment.

If you’ve been seeing a doctor affiliated with Beth Israel, you might be wondering, how does this affect me? Dr. Stuart Rosenberg, who will co-chair BIDCO representing physicians, says “for the first time, we are able to really look at the patient and assess their health care needs no matter where that might be provided.” A doctor will no longer have to see a patient in her office to get paid for delivering care.

Dr. Stuart Rosenberg, co-chair of the new BIDCO

Dr. Stuart Rosenberg, co-chair of the new BIDCO

Under an ACO and a budget that lets doctors decide how to spend money on patients’ care, doctors are “developing care plans that are limited only by our imagination and the law,” says Rosenberg.

He illustrates with the example of Mrs. Jones, a patient with a chronic disease who isn’t taking her medication, is skipping doctor’s appointments and comes to the emergency room when her blood pressure or diabetes get out of control. BIDCO could send a nurse to visit Mrs. Jones, give her rides to appointments and follow-up with phone calls. And the amazing thing, says Rosenberg, is that we can “provide that personalized care and actually save money on top of it.”

Sounds pretty good, huh? But if you have private insurance or MassHealth, there may be a catch. Your doctor will want you to get all or most of your care within his network. He’ll want to make sure he keeps track of you, and he’ll want to avoid writing a check out of his budget to a competitor, especially if that competitor, say Brigham and Women’s, charges more than Beth Israel does to help a woman deliver her baby.

Rosenberg says the doctor’s main allegiance will be to patients and helping them find the best care. Tabb says I’m wrong, that patients won’t face restrictions on where they can go for care. But I’m hearing otherwise from patients at several hospitals that are under a global budget.

If this was simple, a lot of people would have done it a long time ago.

We have a growing number of ACOs in Massachusetts, six, officially, and a handful of hospitals that say they’re ready to adopt the model. How does BIDCO expect to stand out? Tabb and Rosenberg say their emphasis on and investment in primary care will be unique. Some of the other ACOs would disagree, which sounds to me like an opportunity to bargain. Hey, ACOs, what can you do for me? After all, we keep hearing, this is not the nineties, when putting doctors on a budget blew up amid patient backlash. This time, money for doctors and hospitals is supposed to be tied to proof that we are healthier because we’re getting the care we need. So ask for that free massage, why not?

Tabb and Rosenberg will co-chair BIDCO, putting doctors and the hospital on equal footing for decisions, financial and otherwise, and the resulting successes or failures.

BIDCO expects to grow, to perhaps double in size, according to Rosenberg. The press release says hospitals and physician groups that join will “have the flexibility to remain as independent entities.” And then a couple of lines down we read, “hospitals and physicians will collaboratively enter into fully aligned risk contracting.” Translated, that means that if all goes well, everyone makes money, but if one hospital or group of doctors messes up, everyone pays.

So how will BIDCO balance “independence” and “collaboration”? Hey, says Tabb, “if this was simple, a lot of people would have done it a long time ago.”

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  • Reasonable?

    It seems that in MA we’re gearing up for the Apple vs. Microsoft v. Linux wars.

    Which model will work better?
    1. A relatively closed network focusing on keeping costs down and quality competitive eg Steward.
    2. A leaky network as described above with BIDCO.
    3. A very loose network with internal competition and relatively high costs….Partners

    There are other networks in MA, but they are all starting to fall along the spectrum above.

    If the mobile wars are an example, the early advantage will go to the closed network with tightly integrated services. Time will tell if the this structural prediction applies here in MA.