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Accountable care:

Redefning value andsuccess in healthcareDelivering value-based, integrated care for better outcomes

Todays healthcare industry is undergoing a major change:

The transormation to an accountable care model. Governmental,

payer and industry bodies have all proposed healthcare quality measures

designed to improve patient outcomes. Governments, payers and

providers are evaluating these proposals in an attempt to determine

which measures will be adopted.

The move to accountable care will replace the existing ee-or-service

payment model with one based on the delivery o value-based, integrated

care. To achieve and maintain a sustainable healthcare system, payers

and providers will have to evolve their thinking and processes to adapt

to this new model.

Some healthcare organizations have already begun to dierentiate

themselves by building new products and services, orming new

partnerships and reorganizing to address the coming changes. However,

most payers and providers are still struggling to dene the characteristicso an accountable care organization and how to adjust to new requirements.

Everyone involved in healthcare delivery will need to become ocused

on and accountable or the care o individuals. This change will

challenge the ecosystem and the result has the potential to signicantly

improve the healthcare delivery system.

Highlights:

Fee-for-servicepaymentmodelsare

evolvingtovalue-based,integratedcare

Transformationtoaccountablecare

modelswillblurthelinesbetweenpayers

andproviders

Hospitals,physicians,andother

caregiverswillbenanciallymotivatedto

collaborate,andreducewasteand

redundancy

Implementingandutilizingnew

technologiesthatincreaseaccessand

transformdataintousefulinformationwill

improveandcustomizecare

WhitePaperExecutiveSummary

IBM Sales and Distrbution Healthcare


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ow accountable care changes

ealthcare deliveryhe transormation to accountable care models will blur

e lines between payers and providers, and in some cases

ey will disappear. Organizations that continue to think and

t separately will most likely end up losers. The winners

ll be those who ace the change head on, think dierently

d proactively collaborate with others to improve care

d eciencies.

yers will become more closely integrated with care

livery organizations. Some will work with providers to

en jointly-owned clinics. Most payers are expected to

duce the number o in-network providers and include only

ose organizations ocused on oering higher quality care

d achieving better outcomes.

oviders will see ongoing industry consolidation resulting

the alignment o risk sharing and value-based payment

hemes. In addition, provider organizations will build ully

tegrated, sustainable healthcare systems that enable ecient

d fexible delivery o patient services. These new systems

ll enable providers to capture revenue across the entire

ectrum o care; rom the hospital, to the doctors oce,

nic, home and long-term care. Hospitals, physicians, and

her caregivers will be nancially motivated to collaborate,

d reduce waste and redundancy.

ustomized health benets that support the specic needs

individuals will become more common. For example, i a

vernment-unded healthcare patient has a chronic disease

d doesnt drive, they will either receive care at home or

ansportation services to get them to the doctor, even i

ansportation services are not a standard government-unded

althcare benet. For this person, access to transportation or

-home treatment is a necessity or ensuring that proper carereceived and will help them become a healthier and less

stly patient who requires ewer hospital stays.

The transormation to accountable care wont happen

overnight. It will occur in phases. To be ahead o the game,

payers and providers should already be proactively planning

and executing changes that address new requirements.

Achieving success with the new

accountable care modelOrganizations that want to make a successul transition to

accountable care will make undamental changes in how they

do business and provide care. In most cases, those that end up

on top will have taken most, i not all, o the ollowing actions:

1. Establish a strategy and roadmap or change

To realize operational excellence and a successul

transormation, organizations need to determine now how

they want to evolve to meet the changing model and which

internal changes they need to make and what partnerships

they need to orm to ensure success. Once an organization

decides where it wants to play in the uture, it should be airly

obvious what actions will be required to get there.

2. Form new partnerships

Payers and providers will organize in new ways and will

collaborate to improve the health o the population in many

dierent ways. Organizations that group together to prevent

errors, improve outcomes and reduce costs will increase their

eectiveness and emerge as winners. Those who reuse to change

and insist on protecting old structures will be let behind.

3. Embrace ICD-10

The new disease classication codes introduced in ICD-10

mark the biggest change in healthcare coding in decades. An

important building block to enable many uture changes,

ICD-10 includes many new diagnoses and treatment codes

and will be the basis or care moving orward. Organizations

that build an understanding o ICD-10 now, and implement

care models based on it, will benet, as will their patients.

4. Adopt smart mobile technologies

Recent advancements are enabling the use o smarter,

connected mobile technologies to supply or monitor crucial

inormation or patients with specic illnesses. These

technologies can signicantly improve diagnosis, treatment

and condition management while reducing costs. Potential

uses include reporting the time and place that asthmatics use

inhalers, or enabling automatic submission o blood and

weight readings o diabetics, and inorming patients to take

medication or seek treatment when certain conditions exist.

5. Expand patient communication methods

The adoption o social media, text messaging and other newcommunication methods will help organizations more easily

reach and interact with younger patients. For example, i a

patient under 30 is trying to quit smoking and has said that

the hardest time o the day to deal with their craving is right

ater dinner, then you might send them a text at that time to

wish them good luck with their program.

6. Incorporate new technologies and utilize more data

Implementing and utilizing new technologies that increase

access and transorm data into useul inormation will

improve and customize care. These technologies may

include electronic medical records, predictive analytics, data

modeling, health inormation exchanges, health benets

exchanges, remote monitoring, mobile monitoring and

reporting, social media and alternative communications.

The future of accountable care is hereThe transition to accountable care models has begun.

Most healthcare organizations realize they cant sustain

current ee-or-service model and know they will need t

change. Some payer and provider organizations are alrea

orming partnerships and collaborating in new ways to

increase value and improve patient outcomes.

Organizations are implementing new technologies that

enable inormation to be accessed, exchanged and analyz

and patients to be monitored in new and dierent ways

that have never beore existed. The true benet o these

technologies is not in the quantity o data they provide, bin how they transorm data into useul inormation that

make a dierence, and improve value and care.

Accountable care will redene value and success in the

healthcare world as we know it. Organizations that don

respond to the inevitable changes necessary or more sustain

accountable care delivery models may not survive.

For more informationIBM can help governments and organizations make a

successul transition to accountable care. For more

inormation, please visit:

ibm.com/healthcare

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hitePaperExecutiveSummary

M Sales and Distrbution Healthcare

WhitePaperExecutiveSummary

IBM Sales and Distrbution Hea


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Copyright IBM Corporation 2012

IBM Global ServicesRoute 100Somers, NY 10589U.S.A.

Produced in the United States o AmericaMarch 2012All Rights Reserved

IBM, the IBM logo and ibm.com are trademarks or registered trademarks oInternational Business Machines Corporation in the United States, othercountries, or both. I these and other IBM trademarked terms are marked ontheir rst occurrence in this inormation with a trademark symbol ( or ),

these symbols indicate U.S. registered or common law trademarks owned byIBM at the time this inormation was published. Such trademarks may also beregistered or common law trademarks in other countries. A current list o IBMtrademarks is available on the Web at Copyright and trademark inormationat: ibm.com/legal/copytrade.shtml.

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