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Practicing Innovations in Health Care Delivery

Deloitte Insights video

Regardless of what happens with health care reform and other developments, the health care business model is changing.  Accountable care organizations are fundamentally changing the way health care is delivered, pioneering a more collaborative approach that aligns incentives with the value of care delivered rather than the volume of work done. Watch this episode of Deloitte Insights to learn more.


Christopher Scanzera, Vice President and Chief Information Officer, AtlantiCare

John Keith, a Principal and Practice Lead for Care Delivery Innovation, Deloitte Consulting

Dr. Harry Greenspun, the Senior Advisor for Health Care Transformation and Technology at the Deloitte Center for Health Solutions, Deloitte LLP


Practicing innovations in health care deliverySean O’Grady (Sean): Hello and welcome to Insights where today we’ll be weighing opinions on accountable care and how clinicians and consumers are developing and reacting to this health care business model.

Joining us in the studio for this conversation are Christopher Scanzera, Vice President and Chief Information Officer of AtlantiCare, a New Jersey-based integrated delivery network. We have John Keith, a Principal and Practice Lead for Care Delivery Innovation within Deloitte Consulting. And we’re welcoming back Dr. Harry Greenspun, the Senior Advisor for Health Care Transformation and Technology at the Deloitte Center for Health Solutions.

Gentlemen I’m interested to know what’s the motivation for accountable care, and how is this different from existing care models?

Harry Greenspun, M.D. (Harry): Well, what we have to do is improve the quality of care that we deliver while lowering the cost, and that’s going to require aligning incentives -- particularly around paying for the value of care that gets delivered as opposed to the volume of work that gets done -- and focusing on the outcomes that the patients receive.

Sean: John, you agree?

John Keith (John): Yeah I do, but the challenge is this really requires a fundamental change in the way we deliver health care and the roles of all of the different stakeholders. It has to be much more collaborative, open, and have a greater deal of communication and coordination.

Sean: Now Christopher, you have been implementing this model at your organization, so I’m interested to know, how is that going?

Christopher Scanzera (Chris) : It’s been going well for us. We started in early 2010, with some thought leaders around the table. From there it moved into a more formal committee, and then as of recently, we have incorporated our first accountable care organization, AtlantiCare Health Solutions.

Sean: I’d like to turn it back over to you. So if an organization wants to adopt accountable care, what kind of infrastructure is needed?

Harry: Well, they need four foundational elements: they’ve got to be able to share information and have it available at the point of care; they have to coordinate that care across multiple, different facilities, multiple settings, lots of providers; they have to engage consumers in ways they never have before to make sure they are actually making the right choices for themselves and for their families; finally, then with all of this information flowing around, they’ve got to have very sophisticated analytics to monitor the performance of the providers and also the system as a whole.

Sean: And John, your thoughts.

John: All of those things are true; they are the fundamentals. The problem continues to be, and really the opportunity and challenge, is that given the way the market has operated in the past, that infrastructure doesn’t exist. So, as we try and change the models, each organization has to, one, figure out what part of that they want to play in, and then how do you access that. So how do you get information flowing throughout a community and across the continuum? What are the tools and techniques and organizational structures that you need in order to support that kind of collaboration? All of that has to be built. It represents a challenge and an opportunity.

Sean: And Christopher, as we’ve been talking about the infrastructure, what’s been the biggest shift in your organization as you’ve gone about this implementation?

Chris: Well, if you use the four categories that were outlined, there hasn’t really been one major shift. It’s been minor shifts in each of the areas, you know, specifically around the sharing of data. It’s a situation now where, historically, we’ve shared some data inside and outside the four walls of the hospitals. That’s becoming much more prevalent in the delivery of care. Coordinating care across a full continuum, historically, was either inside or outside the four walls. Continuum of care management and continuum of care systems to support that again are coming front and center.

Engaging the consumers and consumerism of health care, we like to call it “consumerism v.2” in terms of health care -- our large investment area right now is around the analytics in terms of payer and provider and combining and consolidating the data. That’s a capability that we’re working very closely on developing right now.

Sean: I’d like to turn it back over to you two. Does that sound like a typical implementation? Does this sound like one that’s ahead of the curve?

John: That’s really kind of the heart of the issue here. There is no typical path down this road. Each traditional player -- so if there’s a health system, a physician, the consumer -- all of the players in the system have to figure out a new role, and there’s no one real clear path. Some are using medical home models to start to kind of build out these capabilities; the government is introducing accountable care organizations for some of the Medicare beneficiaries; there are different vehicles that each institution is kind of capitalizing on to build out the infrastructure, to kind of evolve toward these new capabilities and new roles.

Harry: It really depends on where organizations begin from, and so their next logicical step really varies. So for example AtlantiCare, being an integrated delivery network, has certain advantages in some areas. Other places, which have large physician networks and integrated IT systems, can go about it differently.
Sean: Now, we’ve been talking about the organizational view on this, but Chris, I’d like to turn it over from the customer view. So have you been getting customer’s engaged? If so, how have they been reacting? What’s going on?

Chris: We really, really take a two-pronged approach right now. We have what’s called our access center, the AtlantiCare Access Center, which is basically a single point of entry for anybody in the community, the general population to gain access to and information about the care delivery options and what we at AtlantiCare offer. We also have what’s called AtlantiCare Health Engagement, and the whole point of their existence is to do just that, engage the population generally around health and wellness and other activities that lead to that.

Sean: What about the market at large?

Harry: Engaging consumers is really a huge issue, particularly with accountable care because you have to make sure that people are making the right health choices for themselves and going to the right locations for the type of care they need, and also taking care of themselves in a way that’s important for them. And what’s really new about this is giving consumers the tools that they need but also aligning their own incentives, reducing costs, reducing deductibles -- whatever it is in order to make sure that they’re actually doing things that are actually right for them and right for their health.

John: It’s interesting to note that people consider some of this the health care crisis or the health care challenge. I kind of look at it as the opportunity. We have a pretty fragmented industry; we have a very inefficient industry. While we deliver excellent quality care in pieces, there’s huge opportunities for efficiencies; to consumers there is huge opportunities to improve service, to be more tailored, more engaged with individuals.

So there’s a term we use, volume-to-value, and we’re moving toward value. There’s a lot of opportunity in this marketplace to deliver greater value -- both to the individual, the employer -- all stakeholders than we’ve seen so far.

Sean: All stakeholders, there’s a third leg to this stool here, and that’s the clinicians and the staff. How are they reacting to your implementation?

Chris: In our organization it’s a shift, because historically, we’ve been hospital-centric, and for us it’s a cultural shift to move from hospital-centric to continuum-of-care centric. So at the highest level, that’s what we’re experiencing, and then as people begin to get more familiar with that, they’re able to adapt their roles in terms of how they fit into the new delivery model.

Sean: And, I’m guess that’s probably not unique. So with that in mind, how has it affected the market at large? How are you seeing other stakeholders, clinicians, and staff?

John: Well, one of the big needs in the market is for physician leadership. If you’re going to have more collaborative care, and you’re going to have this view of the whole person, and really be finding new ways of engaging -- so I’m going to have online interventions, as opposed to just going to the doctor or just going to the hospital -- I’ve got whole new ways of engaging, and I’ve got to have physicians that culturally and in a very efficient way will work with each other. That leadership component is a major factor and something that a lot of people are investing heavily in.

Harry: And certainly one of the strongest drivers of engaging physicians is around improving quality, and I think that’s been a real rallying cry for many organizations to get these things going.

Sean: My last question is for all three of you, and I think we can take it like a wave. We’ll go right across the desk, and it’s just the hard lessons learned. So as we’ve been talking about this entire process -- what has been that which you’ve learned, which you feel the audience might most benefit from?

Chris: Sure. I would say in terms of the population that you’re going to attempt to manage in the beginning -- start small with a controlled population. And so it’s a lot easier to affect change in the smaller group than it would be to try to take on more than really an organization can handle.

I’d say secondarily, you have to take a look inside your organization and find those innovative leaders in the typical disciplines; in the clinical care delivery, legal, finance, and IT because the solution is going to come from non-traditional thinking. And then beyond that, look around to see what’s going on. A lot of lessons have been learned in the market space. What I think we have to do is leverage others that have been there, you know before us, and then as others come up behind us, learn from what we’ve done.

And I’d say lastly, really be prepared to fail fast, start again, and regroup. Because we are absolutely in uncharted territory, and there are plenty of mistakes that are going to be made that folks are going to learn from.

Sean: Thank you for that, John?

John: I agree with the main theme that you need to iterate on this. You need to have different experiments that are good for your environment, so AtlantiCare is well-positioned to kind of take a very broad view and start investing in the infrastructure and then pick specific populations, or primary care medical homes, and start advancing on those very quickly.

Your point was about what’s difficult, and what are some of the lessons learned? Some of the behavior changes and attitude changes going forward that have to occur are when many organizations have held onto data. This is a very analytical driven -- this is a very collaborative process we’re going into. In order to be effective, you really need to collaborate. You really need to figure out how to access greater amounts of data, and that sometimes means sharing yours.

It’s a very different dynamic -- changing your mindset to being more collaborative, more open, figuring out what you need to own and what you need to share. This is a big challenge for organizations, but you know they’re stepping up.

Sean: You got to give to get. Harry, last thoughts over to you.

Harry: Well, I think the big thing for people to remember is this is not going away. This is how medicine is going to be practiced. This is how the health care system is going to be run. We need a health care system that’s sustainable, and that means having a health care system that’s aligned to keep people healthy and rewarding people for doing so. So you know, irrespective of what happens with health care reform or other developments, this is the way the world is moving and there are certainly pioneers in this area, but we’re all going to have to be working this way in the future.

Sean: It’s a very interesting topic. Gentlemen, thank you all for your participation today.

Sean: We’ve been examining accountable care with Christopher Scanzera, Vice President and Chief Information Officer of AtlantiCare, John Keith a Principal in Deloitte Consulting, and Dr. Harry Greenspun, a Senior Advisor for Health Care Transformation and Technology at the Deloitte Center for Health Solutions. If you’d like to learn more about Chris, John, Harry, or any of the topics discussed on today’s broadcast, you can find that information on our website. It is For all of the good folks at Insights, I’m Sean O’ Grady. We’ll see you next time.

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