Ted Eytan, MD, MS, MPH Ted Eytan, MD, MS, MPH

Permanente Medical Group Leaders Bernadette Loftus, MD, and Bill Wright, MD, took to the podium (and the dinner table!) at the National Association of Accountable Care Organizations Fall conference and Kaiser Permanente Center for Total Health in Washington, DC.

They led discussions based on the experience of the Mid-Atlantic Permanente Medical Group and Colorado Permanente Medical Group, on the topic of physician-hospital relationships, and how to collaborate effectively.

The plenary session was apropos for an audience of about 500 individuals, mostly comprised of leaders of private and public accountable care organizations. Private and public accountable care organizations (ACOs) are becoming well established, with some 750 such organizations operating in the U.S. as of January 2015 A particularly vexing challenge is the structuring of relationships among physicians and hospitals to support hospital care quality, service, and affordability.

A few issues drive this challenge:

  1. Nearly one in four ACOs are not partnered with a hospital and therefore may lack the collaborative relationship that may be necessary for improving care and cost;
  2. ACOs that are not partnered with a hospital rarely know when their patients have been admitted and therefore cannot influence inpatient care;
  3. Even among hospitals that are financially integrated with ACOs, there is no significant difference in total cost of care for patients, which suggests that factors—such as leadership, culture and governance—may be more important than financial integration in helping doctors and hospitals collaborate effectively.
William Wright MD at NAACOS 2015

Dr. Loftus and Wright covered topics including:

  • Contracting and consolidating business with a single hospital (or a few core hospitals).
  • Health Information Exchange: how are data, best practices, and quality improvement projects undertaken collaboratively?
  • Physician leadership in hospital operations (via opportunities such as a JOC: Joint Operating Committee)
  • Overall strategies for establishing successful relationships with hospitals

Only four hands out of the hundreds in the room went up when asked if they had existing Joint Operating Committees as a part of their contracts with hospitals. Our leaders seeded some ideas with the ACO community, and we anticipate future opportunities to continue the conversation.

Bernadette Loftus, MD and William Wright, MD NAACOS15

The evening prior, Drs. Loftus and Wright led a discussion with a smaller group of physician leaders at the Kaiser Permanente Center for Total Health (@KPTotalHealth). Comments from guests included:

“It’s a very rarified atmosphere (at Kaiser Permanente)”

“We are all dancing around the edges of KP”

As we have seen previously in Washington, DC, a story of clinical excellence is especially powerful when told by those who are continuously innovating and improving, solving problems, and managing the challenges of growth.

The events showed how relevance is enhanced by the high performance of the Kaiser Permanente Colorado (@KPColorado) and MidAtlantic States (@KPMidAtlantic) Regions of Kaiser Permanente (see: Kaiser Permanente Share | Kaiser Permanente Medicare Plans Score Top Ratings for Quality and Service).

Washington, DC and the Kaiser Permanente Center for Total Health continue to be important venues for physician leaders responsible for our clinical excellence to connect with audiences eager to listen and ask questions about the future.

This article originally appeared on Kaiser Permanente’s Center for Total Health Blog.

Blog written in collaboration with Joy Lewis (Kaiser Permanente Institute for Health Policy) and Ann Kempski (The Permanente Federation)


David Muhlestein, “Growth and Dispersion of Accountable Care Organizations in 2015,” Health Affairs Blog, March 31, 2015.

Carrie H. Colla, Valerie A. Lewis, Stephen M. Shortell and Elliott S. Fisher, “First National Survey Of ACOs Finds That Physicians Are Playing Strong Leadership And Ownership Roles,” Health Affairs, 33, no.6 (2014):964-971.

Michael McWilliams, Michael E. Chernew, Bruce E. Landon, and Aaron L. Schwartz, “Performance Differences in Year 1 of Pioneer Accountable Care Organizations,” New England Journal of Medicine, 2015; 372:1927-1936.