Health AGEnda

Fine Old Wine in New Bottles

Posted in category Chronic Disease, Grant Programs


“Everything old is new again” can be said with a sneer and imply that the same failed proposal is being offered once again–as in, “Accountable Care Organizations are just 90s-era managed care warmed over.”  Or it can be said with joy and a wonder that the value of prior work endures and that we may have yet another chance to get it right.

Close readers of HealthAGEnda might recall my comment on the potential value of the National Chronic Care Consortium’s work to this next generation of integrated health systems.   And to my great pleasure a couple of weeks ago, I saw the equivalent of a phoenix rising from the ashes of the National Chronic Care Consortium (NCCC), suggesting that the ideals of the NCCC have been reborn.  On CMS’s Partnership for Patients website, at the bottom of its page of web links among the tools for improving care transitions, was a link to the NCCC.

The NCCC was a group of leading-edge health systems from the early 1990s who foresaw the need to shift from acute disease to chronic care and to integrate care across the full continuum, from primary to acute to home care and long-term care.  They came together to share what they learned and help each other pursue the sometimes very counter-cultural path they had chosen.  Organizations and leaders like June Simmons, then of Huntington Hospital (now at Partners in Care Foundation), Nancy Whitelaw of Henry Ford Health System (now of the National Council on Aging), Chris Fordyce (Himes) of Group Health Cooperative of Puget Sound, and Cheryl Phillips, then of Sutter Health System (now of LeadingAGE [until recently AAHSA]), created a vision of better care for people at higher value to society.

The Robert Wood Johnson and John A. Hartford Foundations were NCCC’s major external funders.  RWJF was working under its large chronic disease initiatives and JAHF under its aging and health program, but with careful attention to what we were learning in our health care cost and quality program.  JAHF made grants in 1991, 1993, and 1996 for a total of $1,000,000 (back when that was real money).  The final grant supported the development of a tool intended to help organizations live up to their commitments to integration:  the SASI Tool (Self Assessment for System Integration).  Its nine objectives, seen in the box below, seem as fresh as ever in a world of electronic health records, care transitions, accountable care organizations, and medical homes.

But by the late 1990s, despite their importance, these ideas fell out of favor as the Clinton health reform package failed and the managed care backlash threw out the care coordination baby with the gatekeeping bathwater.  The tide of system integration with its goals of better care coordination and higher value ebbed in favor of local maximization of benefits to parts of the delivery system and little attention to the whole and the overall patient experience.   By 2003, with major member organizations no longer able to afford either the cash costs of membership or see the relevance of the vision to their day-to-day challenges, the NCCC board voted itself out of existence.

But neither the NCCC leaders, their ideas, or even the NCCC website and products ever went away–they have been with us all along, helping to drive the health system towards being a real system that can meet the ever more urgent needs of chronically ill Americans.  Despite the collapse of the organization and the failure of our hopes for it, I’ve always been proud of the foundation’s relationship to the NCCC.  I’ve even kept some NCCC souvenirs.  If you ever see me in a hotel gym engaged in personal health promotion, take a close look at the blue band I use to hold my glasses in place.

I think that the SASI tool should become part of the the criteria for certifying Medicare Accountable Care Organizations.  Can you think of a more clearly stated foundation defining the key components needed to integrate systems to provide better care for people with chronic conditions? I can’t, but please share if you can.


4 thoughts on “Fine Old Wine in New Bottles

  1. It was with pure delight that I read Chris’s comments about the NCCC. RichBringewatt (the CEO of the former NCCC and now of the National Health Policy Group) has often said that our work at NCCC was just a decade too early. I actually believe that the NCCC was the critical catalyst for what become the focus on chronic care, and eventually lead to the understanding of the need for truly accountable care across settings and professions. In the NCCC days we were talking about the concepts of chronic care and a broken system – back when hospitals were still more focused on tertiary services and where to put the next cath lab. Even more importantly, the NCCC recognized that true integrated and “accountable care” included safe and coordinated transitions – AND that home and community-based services are the essential, and often ignored, element that truly defines safe, high quality and person-centered chronic care delivery that meets the goals of the “triple aim”. We still have much work to do. I share Chris’s perspective that these SASI tools are the essential foundation of a true Accountable Care Organization.

    Thank you Rich for your early vision. Thank you Chris for sharing these tools and now it’s up to us to make sure we create innovative and accountable “communities” that create a person-centered continuum of chronic care deliver “across time, place and profession” (to quote our NCCC mantra)!

  2. Thanks Cheryl – I was just looking through the big box of materials from the ’98 meeting in Minneapolis. Still great stuff and still issues that health reform desperately needs to address. – Chris

  3. Hello Friends/Colleagues – Thank you, Chris, for putting in writing what many have said in the last year to me regarding the work of the NCCC. The work we did on the SASI tool was exciting and a bit revolutionary at the time. I hope some pick it up and put it into action. I recall fondly the year-long experience working with five health systems across the country as they utilized this tool and found out more about what their own settings/services within their continuum were doing than in any internal corporate/system-wide meeting they had ever attended. Hello to all you former NCCC members, visionaries, and leaders on the “full, integrated continuum of care.” We pre-dated the work of the chronic care model too–and that has also been a valuable construct for moving this work ahead. I hope this is the right time and that the former movers and shakers continue to sow seeds and reap benefits. Keep in touch, Deborah

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