University Hospitals: creating the infrastructure for quality and value through accountable care

University Hospitals Health System Inc. (UH), in Cleveland, Ohio, like many hospitals and healthcare systems, sought to anticipate the dramatic changes of healthcare reform, including its increased focus on quality and outcomes. UH evaluated incentives to keep patients out of hospital and to ease mounting pressures on reimbursement and costs. During UH's strategic planning sessions in 2009 and 2010, we identified value--the combination of quality and efficiency--to be a key driver of our future success. Ahead of the enactment of the Affordable Care Act, in early 2010 we chose to proceed with the formation of an accountable care organization (ACO). We believed the ACO was a novel vehicle by which to improve the efficient delivery of our high-quality healthcare to maximize the value of the services we provide. We also believed that the most successful strategy, if it can be achieved, is to build on success. A major success, or a series of smaller successes, will go a long way toward achieving operational buy-in, enhancing respect for strategic initiatives, and convincing physicians of the need for change. Through thoughtful governance, effective plan design, customized data analytics, physician networks and incentives, innovative patient engagement, and supplemental coordination resources, our ACOs have succeeded in improving population health and delivering value.