title: Managing specialty care in an era of heightened accountability: emphasizing quality and accelerating savings.
abstract: OBJECTIVE
  Engaging specialists in accountable care organizations (ACOs) may make them more responsive to pressures to lower costs and raise quality. This paper introduces a novel accountable care design in cardiology.
  
  
  METHODS
  Preliminary study using baseline data.
  
  
  METHODS
  The Accelerating Clinical Transformation for Creating Value and Controlling Cost in Cardiology concept study involved providers employed by the Providence Medical Group, Oregon. First, using claims data from 2009 through 2011, we created a historic budget to capture cardiovascular disease (CVD)-related costs for attributed patients on a per patient per year basis. Second, we introduced a validated quality metric, the Clinical Performance and Value vignette, to a sample of cardiology providers to examine clinical practice variation in treating coronary heart disease (CHD), coronary heart failure (CHF), and atrial fibrillation (AF). Lastly, we analyzed reimbursement claims paid for CHD, CHF, and AF, and forecasted potential cost savings from reductions in clinical variation.
  
  
  RESULTS
  Examining historic costs, we found they were stable over time, but variable by provider and disease. Quality scores, measured against evidence-based cardiology guidelines, ranged from 48.9% to 85.4% (mean=66.8%; SD=5.4%), and the prevalence of unnecessary testing was 46% in CHD, 71% in CHF, and 30% in AF. We project that reducing unnecessary care by 15% to 25% would yield $200,000 to $498,000 in savings ($50-$83 per patient visit) annually. And, if the top 10% of providers as determined by CVD-related costs reduced their costs by 25%, savings would be an additional $283,512 per year.
  
  
  CONCLUSIONS
  This accountable care design framework is timely for cardiology and could be applied for other specialty conditions, such as cancer.
authors.affiliation: QURE Healthcare, 1000 4th St, San Rafael, CA 94901. E-mail: jpeabody@qurehealthcare.com.
authors.forename: John W
authors.initials: JW
authors.lastname: Peabody
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Huang
authors.forename: Riti
authors.initials: R
authors.lastname: Shimkhada
authors.forename: Meredith
authors.initials: M
authors.lastname: Rosenthal
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration*; D001281:Atrial Fibrillation / Q000191:economics / Q000628:therapy; D002309:Cardiology / Q000191:economics / Q000458:organization & administration*; D017046:Cost Savings / Q000379:methods*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006331:Heart Diseases / Q000191:economics* / Q000628:therapy*; D006333:Heart Failure / Q000191:economics / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review; D017410:Practice Guidelines as Topic; D019564:Unnecessary Procedures