Health Affairs

Healthcare organizations across the country are learning how to adapt to the concept of an Accountable Care Organization (ACO). Having been closely involved in Intermountain Healthcare’s evolution as a prototype ACO, we offer our experience in making that transition.

Intermountain Healthcare is a not-for-profit, integrated, healthcare system serving Utah and southern Idaho. With 23 hospitals, a health plans division, and a medical group with 765 employed physicians practicing in 155 clinics, we have worked for more than three decades to continually improve the health and healthcare of patients in our region.

Developing into an ACO can occur along many paths, and no single model fits all. Yet, looking at the journey of Intermountain, one sees many factors—some structural, some cultural—that may be replicable and that could be of value to others making that transition.

Here are 10 key factors that have been critical in Intermountain’s development:

1. A voluntary governance model guided by a common mission. Intermountain is governed by trustees who serve without pay and ensure the organization fulfills its community-oriented mission. That mission is excellence in the provision of healthcare services. It includes commitments to provide care at the lowest appropriate cost (while maintaining financial strength) and to meet the needs of young and old, rich and poor, and urban and rural residents, with sensitivity to cultural differences. Supporting the central Board of Trustees are 16 governing boards (related to hospitals and other services) and 16 charitable foundation boards. In total, Intermountain is governed by more than 450 trustees who provide an essential link between the organization and the communities it serves.

2. A unified management chain that aligns resources and goals and implements best practices system-wide. Intermountain uses a common management structure, supported by the same information systems, policies, and other management tools. Annual goal-setting is coordinated system-wide, based on the goals established by the Board of Trustees. Two interconnecting management chains—management of operations/facilities and management of clinical programs—are interwoven to provide alignment of resources and goals.

3. Unified financial systems that help management understand costs and manage processes. Intermountain was one of the first healthcare organizations in the nation to achieve detailed analysis of its costs in providing care. Today, real-time, activity-based, cost accounting allows managers to analyze and model financial effects at the transactional level. This understanding of the costs of activities has enabled both operational and clinical process improvements.

4. A focus on the continual improvement of clinical quality using a data-driven evidence-based approach. While Intermountain has always had a culture of innovation and improvement, in the late 1980s, Dr. Brent James – a physician and statistician – introduced statistical tools and a theory of continuous clinical quality improvement to the organization. As Intermountain’s chief quality officer, he helped train physicians, nurses, other clinicians, and administrators in the tools and methods for clinical quality improvement. His pioneering work helped lay the foundation for Intermountain’s clinical programs and helped Intermountain demonstrate that in healthcare, higher quality often costs less.

5. Investment in clinical information systems. As early as the 1970s, researchers at Intermountain hospitals were developing computerized information systems to improve the delivery of care. Intermountain has continuously invested in clinical information systems that allow for automation of routine tasks, connectivity and communication, decision-support, and data-mining for quality improvement. Today, Intermountain is working with GE Healthcare to develop these systems for use by other healthcare organizations.

6. Development of an affiliated health insurance plan to support care to a defined population of plan members. Intermountain’s health plans division, now called SelectHealth, has proven extremely useful in supporting Intermountain’s mission. SelectHealth programs encourage members to use preventive benefits in order to maintain or enhance their health status. When members require care, the plan directs them to the most effective settings and treatments.

7. Development of an employed medical group to foster implementation of new practice and process models. Physician engagement allows the healthcare system to affect patient care in the primary care setting, outside hospitals, and facilitates the implementation of medical best practices. For this reason, in 1994, Intermountain established a medical group of employed physicians who practice at Intermountain clinics.  Employment in the group is just one of several possible affiliation options for physicians who wish to care for SelectHealth patients or practice in Intermountain facilities. Some 4,700 physicians are affiliated with Intermountain, including about 765 who are employed by the Intermountain Medical Group.

8. Development of a compassionate, accountable culture. The culture at Intermountain requires strict compliance with all laws, regulations, and policies and brooks no excuses for poor behavior or performance. At the same time, compassion and help are given to employees who act in accordance with Intermountain’s mission, vision, and values. The work environment may be fairly described as collaborative, supportive, and goal-oriented. This culture applies throughout the organization, affecting everyone from the most senior management to the housekeeping staff. The culture is reinforced by compensation practices.

9. A shared commitment to system-wide mission, vision, and values. The mission of the organization to provide high-quality, cost-effective care strongly motivates our workers and aligned professionals. A mission, vision, and values statement helps guide behavior and define the culture. It is essential to realizing a shared commitment.

10. A spirit of innovation across the organization. The cumulative effect of the above key success factors is a “can-do” attitude among the members of the organization. Intermountain employees at every level understand that innovation is an imperative and that constant change is to be embraced.  Employees know that Intermountain is always developing and willing to address difficult challenges. That’s part of our culture and core to our shared commitment.

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This entry was posted on Friday, June 3rd, 2011 at 7:15 am and is filed under All Categories, Health Reform, Hospitals, Innovation, Insurance, Physicians, Quality. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.