The Affordable Care Act is compelling hospitals to shift from a “first curve” of operating in a volume-based environment to a “second curve” of building value-based care systems and business models.

A new report from the American Hospital Association’s Committee on Research examines 10 strategic questions that delivery systems need to ask themselves before driving into that second curve, as well as 10 must-do strategies to come out of the curve.

“Hospital leaders need to proactively develop strategies to achieve the second curve; waiting is dangerous,” report authors contend. “If a fundamental shift in health care happens in three to five years, the time is now for hospital and care system leaders to make strategic, yet swift, movement toward achieving health care’s Triple Aim--improve care quality and patient experience, improve population health and reduce per capita costs. Leaders must heed the best practices and lessons learned in the first-curve environment and apply them to the second-curve environment.

“When and how to move from the first curve to the second curve are difficult decisions. To survive life in the gap, leaders need to develop the capacity to take risks, and getting to the second curve requires greater clinical, financial, operational and cultural integration. Additionally, redesigning care is essential to any future health care state.”

The top 10 strategic questions in the report are:

1. What are the primary community health needs?

2. What are the long-term financial and clinical goals for the organization?

3. Would the organization be included in a narrow/preferred network by a health insurer, based on cost and quality outcomes?

4. Is there a healthy physician-hospital organization (a business model that aligns physicians in private practice with hospitals and hospital-employed physicians)?

5. How much financial risk is the hospital willing or able to take?

6. What sustainable factors differentiate the organization from current and future competitors?

7. Are the organization’s data systems robust enough to provide actionable information for clinical decision making?

8. Does the organization have sufficient capital to test and implement new payment and care delivery models?

9. Does the organization have strong capabilities to deliver team-based, integrated care?

10. Is the organization proficient in program implementation and quality improvement?

Report authors also offer 10 must-do strategies for hospitals and delivery systems, with the first four as major priorities:

1. Aligning hospitals, physicians and other providers across the continuum of care.

2. Utilizing evidence-based practices to improve quality and patient safety.

3. Improving efficiency through productivity and financial management.

4. Developing integrated information systems.

5. Joining and growing integrated provider networks and care systems.

6. Educating and engaging employees and physicians to create leaders.

7. Strengthening finances to facilitate reinvestment and innovation.

8. Partnering with payers.

9. Advancing an organization through scenario-based strategic, financial and operational planning.

10. Seeking population health improvement through pursuit of the Triple Aim.

The report, “Your Hospital’s Path to the Second Curve,” is available here.

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