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Understanding the Difference

Compare Accountable Care
& Traditional Care

Bill Gipson

Bill Gipson woke this morning with heart palpitations. Follow Bill’s experience to understand how health care delivered in a traditional system differs from care delivery in an accountable care system.

Defining Moment #1
Getting an Appointment
Traditional
  • Calls for appointment with his doctor.
  • Bill gets an appointment 5 days later when his doctor returns from vacation.
Accountable
  • Calls for an appointment with his doctor.
  • Bill’s doctor is out, but he gets a same-day appointment with another doctor in the group.
Defining Moment #2
At the Appointment
Traditional
  • Doctor views paper records of Bill's medical history, or perhaps a computer file stored only in that office.
  • Doctor thinks about what could be wrong, does an EKG test, orders urine, blood and treadmill tests.
  • Test results will be available in a few days. Bill is told "no news is good news." Doctor tells Bill he should lose weight.
  • Bill leaves appointment trying to remember what's been done, and what he needs to do next.
Accountable
  • Doctor views an electronic medical record that includes info from all of Bill's care providers.
  • Doctor thinks about what could be wrong, reviews current medical guidelines on computer, and decides to order EKG test, urine, blood and treadmill tests.
  • Doctor tells Bill he needs to lose weight. Test results will be available online in a few days. Doctor will call Bill to discuss lab results.
  • Bill leaves appointment with written end-of-visit summary explaining what has happened and what to expect next.
Defining Moment #3
Referrals to Specialists
Traditional
  • Doctor refers Bill to cardiologist. Bill can make cardiology appointment after he receives the authorization letter from health plan.
  • If Bill wants his cardiologist to see the full picture of his health history, Bill must deliver his own medical record to the cardiologist.
Accountable
  • Doctor refers Bill to a cardiologist with automatic approval from health plan, so cardiology appointment can be booked for Bill before he leaves his doctor’s office.
  • The cardiologist will see Bill’s entire health picture because he is connected to Bill's central electronic medical record (EMR).
Defining Moment #4
Prescriptions
Traditional
  • Bill carries his paper prescription for blood pressure medication to pharmacy across town.
  • Waits an hour for prescription to be filled while sitting in the pharmacy.
Accountable
  • Bill’s prescription is electronically transmitted to his favorite pharmacy.
  • Prescription is ready for pick up when Bill arrives at the pharmacy.
Defining Moment #5
Specialist Appointment
Traditional
  • Cardiologist can’t find faxed notes from Bill’s doctor, so he repeats tests for blood pressure and EKG.
  • Cardiologist wants to write Bill another prescription for his blood pressure. Bill says he already has one but can’t remember what type or dosage.
  • Cardiologist notes his findings in his paper file at cardiologist's office. Report is faxed to Bill's doctor, and gets deposited into Bill's paper medical record there.
Accountable
  • Cardiologist has real-time access to test results and primary care doctor notes through Bill’s shared EMR. No tests are repeated.
  • Cardiologist views Bill’s current prescriptions in his shared EMR and avoids prescribing unnecessary duplicate medications.
  • BiIl's doctor reviews the cardiologist’s findings online after notification through EMR that cardiologist has added notes to Bill’s record.
Defining Moment #6
Lab Results
Traditional
  • Bill never hears anything from his doctor about lab results. He assumes everything is okay, but never really knows.
Accountable
  • Bill receives email notification and logs into his secure patient portal to view full lab results online, read patient education about specific diets he should follow, and request an appointment for follow up. His primary care team calls him to review results again so Bill understands importance of managing his weight.
Defining Moment #7
Follow Up
Traditional
  • After cardiologist checks him, Bill is told he must lose weight and manage blood pressure to prevent heart attack.
  • Bill takes a pamphlet listing local classes on managing stress and weight, but leaves pamphlet in his car.
  • Bill doesn’t hear anything from his primary doctor or the cardiologist after being advised to lose weight and better manage his blood pressure.
Accountable
  • After cardiologist checks him, Bill is told he must lose weight and manage blood pressure to prevent heart attack.
  • Cardiologist' assistant reviews health education classes available to Bill and schedules appointment with nutritionist.
  • Bill gets a call from his primary care team to reinforce cardiologist findings and set a treatment plan for weight loss and blood pressure.
  • Bill gets a phone call to schedule regular follow-up appointments with his doctor to monitor his progress.
Susan Healey

Susan Healey hurt her knee during a recent training run, and found herself in the emergency room. Follow Susan’s experience to understand how health care delivered in a traditional system differs from care delivery in an accountable care system.

Defining Moment #1
Getting an Initial Diagnosis
Traditional
  • ER doctor X-rays Susan’s knee, sends her home with a splint and tells her to see her primary care doctor for follow-up.
  • X-ray images stay at the ER until requested by Susan or her doctor.
Accountable
  • ER doctor X-rays Susan’s knee, makes a preliminary diagnosis.
  • The ER nurse immediately schedules appointment with orthopedic surgeon who specializes in diagnosing and treating sports injuries.
  • X-ray images automatically added to Susan’s electronic medical record.
Defining Moment #2
Prescriptions
Traditional
  • ER doctor is unaware of Susan’s blood pressure medication.
  • ER doctor prescribes a common but potentially dangerous pain medication.
  • Pharmacy is across town. Susan picks up medication later that night.
Accountable
  • ER doctor is aware of Susan’s blood pressure medication (and complete medical history) through her electronic medical record.
  • ER doctor prescribes a pain medication that is safe with Susan’s other medications.
  • Prescription is automatically faxed to Susan’s pharmacy. She picks up her prescription on her way home.
Defining Moment #3
The Follow-up Appointment
Traditional
  • Susan calls her primary care doctor for an appointment the morning after she returns from the ER.
  • Her doctor is on vacation, so she waits 3 more days to see her doctor to get a referral to orthopedist.
  • Waits another week to see the orthopedist.
Accountable
  • ER nurse schedules appointment directly with orthopedic specialist in Susan’s medical group.
  • Primary care doctor appointment not necessary for referral to specialist.
  • Susan sees the specialist within a couple days.
Defining Moment #4
Getting Advice After-Hours
Traditional
  • Her knee feels worse, so she calls for advice at night.
  • Doctor’s office is closed.
  • Gets advice from doctor next day during regular business hours.
Accountable
  • Her knee feels worse so she calls for advice at night.
  • Susan’s medical group answers her call with its 24-hour nurse hotline.
  • Nurse advises the right way to take care of her knee.
Defining Moment #5
Getting a Final Diagnosis
Traditional
  • Sees the specialist more than a week after the ER visit.
  • Must pick up and bring her own X-rays to the specialist, but she forgets.
  • Orthopedist repeats the X-ray before ordering a costly CT scan, which requires a fourth appointment.
Accountable
  • Sees the specialist two days after ER visit.
  • Orthopedic surgeon reviews X-ray through EMR before Susan even arrives.
  • MRI is ready to be performed when she arrives at the specialist.
Defining Moment #6
Continuing Care
Traditional
  • Three weeks after ER visit, Susan reports for physical therapy.
  • Therapist knows nothing more about Susan’s health other than her knee sprain.
  • The therapist makes paper notes about Susan’s treatment and progress, which are filed at therapy center.
  • Susan forgets to schedule her two-month follow-up with her primary care doctor.
  • Susan’s medical condition continues to decline because of missed prevention opportunities.
Accountable
  • Ten days after her ER visit, Susan reports for physical therapy.
  • Therapist has a complete view of Susan’s medical situation and designs a therapy program perfect for her.
  • Therapist types notes directly into Susan’s EMR so the entire care team can keep track.
  • Two-month follow up appointment is scheduled automatically by her primary care doctor’s computer system.
  • At the follow-up appointment, Susan’s doctor gets reminder from computer about flu shot, screening mammogram, and a blood pressure check. Susan gets an end-of-visit summary from her doctor explaining what has happened during her visit and what’s next.

What Is Accountable Care?