On the long and winding road toward an accountable care organization, healthcare providers have to expect the potholes and steer around them.

"It's a philosophy. It's a process that takes time," said Stephen Rosenthal, MBA, vice president, network management at Bronx-based Montefiore Care Management on Sunday in the opening keynote to Sunday's Accountable Care Organization Symposium. "It doesn't happen overnight and there are no magic bullets."

While the daylong symposium sought to tackle several aspects of the fee-for-value process, Rosenthal tried to break down a complex process to a simple concept: "It's all about the patient." 

At Montefiore, that process began in 1996 with the Care Management program. Through the years, health plans, nursing homes, mental health providers, post-acute care services, even homeless and palliative care programs, were brought into the mix. Each had a distinct and important role to play in population health management.

Most important, Rosenthal said, were the doctors. "We felt we needed to form a club," he said. "It's a very slow process to build trust."

Rosenthal said administrators sought to identify the population that an ACO would benefit the most – the 20 percent of patients that make up 80 percent of the health system's costs. They then developed a care management program that would not only help them, but identify people moving toward that population.

Throughout that process, Rosenthal said it was important to remember that while 20 percent of the population accounted for most of the costs, 100 percent figure into the quality of care. 

Not all the pieces of the puzzle fit perfectly at first, but they worked out eventually. "We spent the next decade learning how to make mistakes and not get fired," Rosenthal said.

The results have come, though. Now in its third year as a Pioneer ACO, Montefiore is building on 7.2 percent savings from its first year, and has seen a 10 percent reduction in inpatient admissions, a 35 percent reduction in all-cause readmissions and a 45 percent reduction in diabetes inpatient admissions.

Rosenthal said Montefiore now handles about 300,000 covered lives, and he wants to push that number up to a million. 

"An ACO isn't an acronym," he said. "It's a lifestyle."