With new payment models beginning to change the way hospitals and health providers are reimbursed for their services, health plan payers scrambling to control unsustainable medical costs and health information technology linking up the patient care silos, a more integrated and patient-centric care model is emerging out of the chaos of a health system in transformation.
Two terms point to the changes sweeping health care: “accountability” and “integration.” Both are fueling the rise of accountable care organizations as Medicare, Medicaid and commercial payers shift from a costly fee-for-service payment system to a new, evidence-based reimbursement model based on successful patient outcomes and reduced hospital re-admissions. Making the process possible: the integration of care as hospitals, physician groups, clinics, testing labs, pharmacies and other members of the healthcare team begin to create a more holistic, patient-centered model of treatment and prevention.
The rise of evidence-based payments is spurring the creation of both hospital/community care partnerships and ACOs to build new bridges to patients, improve continuity of care and cope with the new reimbursement paradigm. Forward-thinking pharmacy operators are scrambling to adapt and stake a solid claim to the ACO model being hammered out by hospitals and regional health systems across the country.
“With payers moving toward paying for quality, … the only way to have solid quality is to protect the continuum of care,” noted Ken Berndt, CEO of Careworks Convenient Healthcare, the clinic division of Danville, Pa.-based Geisinger Health System. “If we’re going to get paid that way, you’ve got to have an ACO, and you have to have some retail [pharmacy and clinic component] for patient access.”