Volume to value: A successful hospital's 5 best practices

MeyerThe recent Supreme Court decision on the Affordable Care Act (ACA), upholding federal subsidies for consumers purchasing insurance through exchanges, solidified the law’s reach and impact across the healthcare sphere. Chief Justice John Roberts’ statement that, “Congress passed the Affordable Care Act to improve health insurance markets,” points to the fundamental issue in medical care today: How can health providers deliver the quality of care that patients deserve and demand, while controlling the cost curve?

While the ACA primarily focused on the adult population, the considerations of cost and quality are not lost on those serving in the pediatric realm. In reality, the issues are just as acute, particularly for pediatric hospitals that operate as independent entities.

Since 2002, Phoenix Children’s Hospital, Arizona’s only such pediatric hospital, has been working toward delivering high quality care while managing the cost of that care.

Toward the achievement of these goals, Phoenix Children's realized as an institution that a fundamental change was necessary to adapt to the shifting landscape, particularly as the ACA instituted new regulations, mandates and criteria to achieve its access and affordability charge.

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The hospital's leadership team looked at how the foundational practices of accountable care, including improving quality outcomes and focusing on population health management to control costs, could be implemented at the pediatric level, by delivering on transparency, quality, and efficiency.

Initially this approach was hospital-centric, a methodology based on moving from the traditional fee-for-service model to value-based contracting, which distributes the savings associated with improved outcomes. But Phoenix Children's saw even greater potential by encompassing the entire continuum of care. By doing so, it realized that the scope and scale of benefits could be significantly expanded.

The hospital found that 92% of all care interactions occurred outside the hospital; an insight that pushed it to incorporate the breadth and depth of assets and competencies across its infrastructure.

The result is Phoenix Children’s Care Network (PCCN), a collaborative integrated system of care encompassing general pediatricians, independent pediatric specialists, Phoenix Children’s Medical Group and the hospital's own sites of service, including urgent care and surgery centers.

Started in 2013, PCCN is a pediatric clinically integrated organization (CIO). Its members include more than 800 providers. More than half of all general pediatricians in metro Phoenix are members, as are the majority of pediatric subspecialists.

 

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