Early experience of a safety net provider reorganizing into an accountable care organization.
Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk.
Allegheny County Health Department.
Karen
K
Hacker
Brandeis University.
Palmira
P
Santos
Perfect Health, Inc.
Douglas
D
Thompson
Harvard University.
Somava S
SS
Stout
Institute for Community Health.
Adriana
A
Bearse
Brandeis University.
Robert E
RE
Mechanic
D060866:Accountable Care Organizations; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D008404:Massachusetts; D008484:Medicaid; D015279:Organizational Culture; D064876:Safety-net Providers / Q000191:economics; D014481:United States