Delivering Powerful Results for Large Minnesota Health System on Their Journey to Accountable Care

Executive Summary

In 2008, Carol was engaged as a partner with a Minneapolis health system on their journey to becoming an Accountable Care Organization (ACO). Carol Corp., whose mission is to transform the delivery and financing of health care by ensuring that innovative providers realize the financial benefit of delivering market-leading clinical performance, was engaged by a large Minneapolis health system to be its partner in their transformation to value-based care. This system's goals were aggressive and ambitious — reduce total cost of care growth rate by 20 percent, increase by 50 percent the number of patients per clinic physician, improve quality of care measures, and improve patient satisfaction.

Carol's client partner chose a demonstration project format and operated within an "ambidextrous" model of putting innovation on a separate track from day-to-day operations. The demonstration program was installed in four clinics, with all clinical team members developing new methods for patient care that better addressed patient's clinical needs, care preferences and schedule. In other words, Carol helped change the sociology of the practice culture within each clinic – resulting in more patient centered care delivery, higher patient satisfaction. Interestingly, clinician job satisfaction also increased.

Carol designed and managed a fast-paced innovation process to redesign primary care — the people, processes and technologies — and create a robust, advanced medical home to manage population health. The Carol care delivery redesign process is a proven, comprehensive approach to providing high-quality care: The right care, at the right time, in the right setting and in the most efficient and effective manner. The Carol care redesign process includes two fundamental elements — team-based care delivery and the development and installation of "care packages" for chronic conditions, procedures and preventive care. The Carol team-based care delivery model ensures that all clinic staff work to the full extent of their licensure.

Based on identification of maximum efficiency opportunities and in consultation with the client, Carol developed nine care packages for specific chronic conditions and procedures. Each care package is a set of evidence-based processes, clinical workflows and point of care tools, designed to achieve pre-established goals and deliver predictable, high-quality health outcomes for specific conditions and procedures. The Carol care packages also improve operational efficiency and patient experience.

Carol provided proprietary analytics of financial, administrative and clinical data to identify key value drivers of clinical performance. Working side by side with the clinic teams, Carol used the analytic findings to focus and guide a design process to create innovative solutions to improve outcomes. Carol continues to provide population health management tools to assist in clinical decision making and to monitor the performance of existing care packages.

The care packages developed for this client cover a cross-section of conditions and procedures, including:

• Adult asthma
• Adult preventive
• Coronary artery disease
• Diabetes
• Hyperlipidemia
• Hypertension
• Kidney disease
• Low back pain
• Migraine
• Prenatal care

Carol and this client partner share the view that successful care redesign on the path to becoming an ACO must include constant monitoring of clinical performance, re-evaluation and improvement of clinical quality, reliability and operational efficiency.

The Results

Carol's care redesign process, combined with payment that rewards this higher level of quality and efficiency, is a cornerstone of becoming a financially successful ACO.

Carol's experience with this large health system has produced tremendous outcomes. The four clinics that participated in the demonstration showed a reduction in cost of care and a measurable improvement in quality of care. Benchmarked against a cohort of all this system's clinics that did not participate in the demonstration, the four participating clinics delivered a 6 percent total cost of care annual savings and outpaced the quality improvement results of the comparison group. As a result, the client is now implementing this new care redesign model in all of its primary clinics. This diffusion is scheduled for completion by January 2011. Work is also underway for the creation of population health models and care redesign for the acute care and specialty care settings. Some of those efforts include effective transition from hospital to home, appropriate staging and referral criteria, and specialty care disease management.

By partnering with Carol to use its ACO strategy of simultaneous care and payment redesign combined with enabling clinical performance management tools, this Minneapolis-based health system is truly reforming health care and is a national leader in the ACO movement. Carol is proud of its work with this system in creating a new value chain in health care that improves quality, patient experience and reduces costs with measurable and reliable results.