Faced with a changing payment system, Billings Clinic in south central Montana is creating a culture of collaboration that puts patients’ needs first, according to CEO Nicholas Wolter, MD. Wolter acknowledges the many challenges providers face, including understanding the costs of care and coordinating care across the continuum. “When it’s the right thing to do for patients, we’ll be able to tackle these challenges,” Wolter said in a recent conversation with hfm.

Q: What key areas do hospitals need to focus on to succeed under healthcare payment reform, especially provisions that encourage formation of accountable care organizations?

A: Accountable care organizations, in the true sense, have to have the ability to take care of patients as they cross silos and over a period of time. You’re accepting accountability not only for the patient admission, but also for all the care 30 days postoperatively. Obviously, strong relationships between hospitals and physicians, including primary care physicians who might not necessarily work in the hospital setting anymore, are critical, but relationships with long-term care and home health providers are also important. These relationships will need to become more formal, and governance structures will need to be created so people can find ways to split bundled payment, for example.

Other areas are important, too. The shared-savings model that is part of the accountable care organization legislation require...

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