Accountable Care Organizations: What is the role of the pathologist? What are the public policy implications?

David Gross, PhD, Director, Policy Roundtable Kavita Patel, MD, The Brookings Institute Elizabeth November, JD, MPH, Centers for Medicare and Medicaid Services Donald S. Karcher, MD, FCAP, Professor and Chair of Pathology, Director of Laboratories, The George Washington University Medical Center

David Gross, PhD Highlights from Policy Roundtable White Paper on ACOs May 7, 2012

Goals for Presentation Share findings from CAP’s case study of three ACOs where pathologists have taken leadership roles Highlight barriers to and opportunities for pathologist success in an ACO environment Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs

Background Review What is an ACO? o A network of health care providers accountable for the costs and quality of health care services provided to a defined group of patients o ACOs exist in many forms − Medicare − Private sector

Background Review (continued) Why should pathologists care about ACOs? ACOs visited

Goals for Presentation Share findings from CAP’s case study of three ACOs where pathologists have taken leadership roles Highlight barriers to and opportunities for pathologist success in an ACO environment Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs

Findings We identified four common ways in which pathology and laboratory medicine provide a “value add” in ACOs 1.Development of protocols for laboratory ordering 2.Population health management

Findings (continued) We identified four common ways in which pathology and laboratory medicine provide a “value add” in ACOs 3.Improving physician access to actionable data from the laboratory 4.Greater collaboration with other clinicians

Findings (continued) We also identified challenges that both pathologists and ACO leadership are facing: 1.How to pay pathologists for their contributions 2.Improving the capabilities and interoperability of HIT systems

Findings (continued) We also identified challenges that both pathologists and ACO leadership are facing: 3. The difficulties of culture change − For pathologists − Of how other clinicians view pathology

Goals for Presentation Share findings from CAP’s case study of three ACOs where pathologists have taken leadership roles Highlight barriers to and opportunities for pathologist success in an ACO environment Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs

Opportunities for Pathologists Pathologists—working with other clinicians—have the opportunity to develop evidence-based guidelines for optimal use of laboratory tests to: Monitor the health status of patients with chronic disease Detect illness in at-risk patients Facilitate initiation of treatment interventions

Barriers for Pathologist Participation in ACOs Many practices lack the expertise needed to make these kinds of ACO contributions Particularly true for small- and medium-sized practices Areas for greater expertise may include laboratory medicine, molecular testing, and informatics How to pay for enhanced expertise is not clear

Recommendations for Pathologists Seeking to be Active in ACOs Be proactive Reach out to local ACO organizers and leaders Explain how pathology and laboratory medicine contribute to ACO goals Seek leadership position by joining ACO committees Join CAP’s ACO Network at

Recommendations for Pathologists Seeking to be Active in ACOs Document how pathologists have contributed to enhanced outcomes, more appropriate care, and cost reductions for the ACO

Goals for Presentation Share findings from CAP’s case study of three ACOs where pathologists have taken leadership roles Highlight barriers to and opportunities for pathologist success in an ACO environment Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs

Policy Recommendation #1 ACOs should establish an advisory board that recommends clinical laboratory testing protocols and guidelines.

Policy Recommendation #2 CMS should encourage or recommend that patient electronic health records (EHRs) allow for bi-directional exchange of data between the pathologist and other relevant health care providers.

Policy Recommendation #3 CMS should study the extent to which patients and smaller health care practices in rural areas are able to take advantage of any cost and quality improvements that may be associated with ACOs.

David Gross, PhD, Director, Policy Roundtable Kavita Patel, MD, The Brookings Institute Elizabeth November, JD, MPH, Centers for Medicare and Medicaid Services Donald S. Karcher, MD, FCAP, Professor and Chair of Pathology, Director of Laboratories, The George Washington University Medical Center Panel Discussion