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Michael Murphy was appointed president and CEO of accountable care for Iowa Health System in April 2012. In the newly created position, Murphy is leading Iowa Health’s transition from a fee-for-service payment model to one based on rewarding cost-effective, quality care. The system-wide transition for Iowa Health is taking place through accountable care organization (ACO) agreements with Wellmark Blue Cross and Blue Shield as well as through Medicare’s Shared Savings Program. Before moving to Iowa, Murphy served as executive vice president for health networks for Trinity Health in Novi, Mich. Originally from Maine, Murphy married a Wisconsin native and has spent the majority of his career in the Midwest.

How do you describe the ACO concept to someone who’s not familiar with it?

I approach it from two perspectives. From the patient perspective, it’s all about patient-centered care and for the patient to have a different relationship with the health provider. It’s a relationship in which the (health providers) are more proactively looking at your health-care needs and anticipating those needs to get better patient outcomes at better costs. So for diabetic patients, for instance, are you managing your blood sugar levels? From the organization’s perspective, it’s moving away from one that rewards you for the number of procedures performed towards one that incentivizes you for having better quality at lower costs.

Tell me about your previous role in establishing an ACO in Michigan.

In that position, I spent most of my time focusing on what were the essential capabilities that we needed in each of our markets to manage the health of the populations. What did we need to have the right IT capabilities, the right governance structures? I would say we were really advanced in getting out in front of (health-care reform) early. One of the reasons I moved to Iowa Health was because it was moving forward with (accountable care organizations) by becoming involved in the Medicare Shared Savings Program.

What are the major steps that have been taken to get this started for Iowa Health?

From an overall resourcing perspective, it’s coordinating care across the continuum based on where people are in the system. It’s things like establishing care navigators, (online) patient portals, having very evidence-based care protocols, putting chronic care management teams together in each of our markets to treat those patients who are very complex patients. The subject area is really around governance. The changes are very different depending on the location, so you have to have physicians sitting at the table, all coming together in a governance structure focusing on the triple aim: better quality at lower cost with higher levels of patient satisfaction.

What are the biggest challenges in moving from a fee-for-service model?

From the patient perspective, patients are used to waiting until they have to go to the doctor. One challenge will be to get patients to be more accountable for their care on a proactive basis. The other is moving physicians away from the mode of doing more (procedures) to being more focused on value-based care. That’s the biggest challenge, when for years they’ve been rewarded for doing more procedures. So (doctors) have a foot in two different canoes; instead of looking at every patient as a 15-minute visit, we will have to look at how to balance that (when needs are more comprehensive).

How involved is each of Iowa Health’s hospitals in this effort?

Virtually every one of our markets is well along; Des Moines is very involved. And of course, Fort Dodge has been involved early on as a (Medicare) Pioneer system. Iowa Health has been working on this for several years and is seen as one of the most advanced (ACOs) in the country.

What types of community involvement do you enjoy?

My wife and I have historically been very involved with our church, and we have gotten active with our church here. I have also chaired United Way and economic development organizations in the past, and I’ve been involved with youth cycling programs in different parts of the country.

So cycling is a hobby?

Both mountain biking and road biking, as well as cross-country and downhill skiing. Des Moines has been great for cycling, with all of the path systems. We think Des Moines is one of the Midwest’s best-kept secrets. It’s amazingly friendly.