Beth Israel shifts to accountable care system

Beth Israel Deaconess Medical Center is launching a new organization with doctors and other hospitals, adapting to a national movement toward payment systems that provide a single, set fee to care for each patient’s health.

The new Beth Israel Deaconess Care Organization, formed with the medical center’s physician group and partner hospitals, aims to improve care by emphasizing wellness over treatment.

“We won’t be incentivized if patients come back again and again — that’s the way it is now,” said Beth Israel president Dr. Kevin Tabb. “We will all do better when patients are healthier.”


Tabb said the creation of the so-called accountable care organization caps more than a year of work since he became president in October 2011.

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In launching the new organization, the medical center and the Beth Israel Deaconess Physician Organization agreed to invest a total $12 million per year over the next five years in care management and infrastructure improvements meant to promote seamless coordination among doctors and hospitals.

Patients will notice few changes, Tabb said, but might find doctors more focused on keeping them healthy than treating them when they are sick.

“The traditional model has been that we take care of very sick people when they show up at our door, and then we don’t think about them after that,” said Tabb. “And that’s never felt right.”

In an accountable care organization, health care providers agree to care for a patient throughout the year for a set fee, rather than bill the patient’s insurance company or the government for each service provided. The new system rewards doctors and hospitals that offer efficient care because providers can share cost savings with insurers under some circumstances.


Accountable care is one of the cost-saving strategies promoted by the 2010 national health care law.

One in 10 Americans now receives health care through an accountable care organization, according to a study published late last year by the consulting firm Oliver Wyman.

The model is a natural fit for health care organizations with many doctors and a range of facilities, such as Partners Healthcare and the Steward Health Care System. For an independent hospital such as Beth Israel, which treats many patients with serious illnesses and unpredictable health care costs, a fixed payment system is less appealing.

But Tabb said the hospital recognized that “there has never been a time when the combination of quality and cost has been so important in this country.”

The new accountable care organization spreads risk among Beth Israel, physicians, and smaller community hospitals — including Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess, and Hospital-Needham.


The arrangement required a lot of work to hammer out but satisfied all parties, said Dr. Stuart Rosenberg, president of the Beth Israel Deaconess Physician Organization.

Rosenberg said an important provision of the deal rewards primary care doctors first in the event of a payment surplus.

“They’re the ones who coordinate care for patients with chronic conditions and the ones best positioned to cut out waste, not the radiologists and cardiologists, as important as those people are,” Rosenberg said. “I’m pleased with the way we focused our attention on primary care.”

Callum Borchers can be reached at Follow him on Twitter @callumborchers.

Correction: An earlier version of this story incorrectly identified two hospitals as part of the new organization.