Q: How do you define accountable care?
Mark McClellan: An accountable care organization is a group of healthcare providers taking accountability for the results of care for a population of patients.
Q: Why do you think accountable care is a pressing health policy issue?
Mark McClellan: WISH has focused on finding new and innovative ways to keep people healthy including models that don’t fit into our traditional health care policies such as paying for care delivered at home, prevention-oriented care, or steps to encourage and support people in changing their behavior. Accountable care is about shifting the focus from delivering services or silos of healthcare to what really matters the most: improving patient outcomes and keeping overall cost down.
Q: What do you find so rewarding about this area of research?
Mark McClellan: Many people think that accountable care is about paying for better health care and new models of care. That is part of it. But the main issue is aligning our health care policies with what really matters to doctors and patients. The most rewarding thing for me is seeing not only happier and healthier patients, but also healthcare providers feeling reinvigorated about helping their patients lead the best lives possible.
Q: Can you speak about your background, your direct experience with accountable care in the United States?
Mark McClellan: I have had first-hand experience of internal medicine as well as policymaking in my capacity as the administrator of our Centers for Medicare and Medicaid Services, CMS, in US. As an administrator, I met with leaders of some healthcare organizations who were taking new steps to try to keep their patients healthy such as adopting team-based approaches to care and electronic reminder systems. They could show me results indicating that those steps lead to better outcomes for patients and lower costs including lower cost for Medicare. However, because of the way Medicare policies were set up, they were not getting any support for implementing these reforms. My experience in both clinical care and health policy has really driven us to focus in our current work on making it easier for clinicians who want to have the policy support, for improved healthcare, in place to do that.
Q: There are a lot of incentives to finding cost savings in other industries but in healthcare there is resistance to that, can you explain why?
Mark McClellan: In numerous other industries, if you make a product or deliver a service that is better and costs less, you are going to get some financial benefits from that, your market will get bigger, you’ll get paid more. In healthcare, it often doesn’t work that way due to regulatory barriers. For example, if you are approaching care delivery with a different set of care providers, not necessarily doctors, there may be licensing regulations that get in the way, or if you are delivering care in a home base setting as opposed to in a clinic or in a hospital, you might not be able to get paid for that. So there are a lot of barriers that may not exist in other industries.
Q: In your opinion, what are the most important factors that lead to the success of accountable care?
Mark McClellan: The core principle is paying attention to the local context starting with what matters to patients. In other words, it is not just about financing or regulations but the best approach to care delivery. Accountable care is about health care providers being responsible for not only whether a patient got certain tests done at their visit, or whether a hospital discharged a patient safely, but really about the whole spectrum of care, which can be pretty daunting. So another key principle for implementing accountable care is to start incrementally.
Q: Can you talk about the pilot project here at Al Wakra?
Mark McClellan: It’s been a real privilege for me to work with a range of health care providers and leaders on adapting accountable care principles in Qatar. Diabetes care and diabetes prevention is a high public health priority in Qatar. The pilot in Al Wakra presents an opportunity to improve care and potentially avoid costly complications. This project is a collaboration between Primary Health Care Corporation, Hamad Medical Corporation and Ministry of Public Health, working together with a focus on identifying the risk factors for diabetes, engaging patients early, and delivering coordinated care throughout the whole spectrum of care needs that a diabetic patient might have.
Q: Can you talk about some of the early findings?
Mark McClellan: One of the most interesting findings is the high degree of patient satisfaction. By looking at risk factors, the proactive program reaches out to people to let them know that they can get screened for diabetes and start working with their health care providers to prevent future complications. The other good news is that a lot of cases of pre-diabetes and diabetes have been identified allowing people to be treated effectively so they can enjoy a longer and better life because of this program.
Q: Tell us about WISH and about the significance of your having the opportunity to pursue this research in the WISH Forum and how your research, as a consequence, has elevated.
Mark McClellan: Working with WISH offers two big advantages. First, WISH is a global forum that truly brings together leaders from the entire spectrum of nations around the globe. The forum has been extremely helpful in gaining insight into applying accountable care in different countries, countries that face common challenges, such as the growing burden of chronic diseases. Second, given the close connection between WISH and Qatar’s health improvement goals, we have the opportunity to test out some of the new ideas right here. We hope that Al Wakra pilot program, which has a lot of applicability in the region and around the world, will be expanded nationally.
Q: What do you hope that the impact of your research will be worldwide?
Mark McClellan: We have two main hopes: to have the opportunity to share our research with world leaders and give them a chance to think about ways that they can change health policies in their countries based on our findings; but more importantly, WISH is about supporting implementation, which has been true for our work here in Qatar and in other countries around the world.