An ACO by Any Other Name
Two presenters at the recent Medical Group Management Association annual meeting described their care delivery models in a way that made them sound an awful lot like an accountable care organization. But both speakers shied away from using the term.
Two presenters at the recent Medical Group Management Association annual meeting described their care delivery models in a way that made them sound an awful lot like an “accountable care organization.” But both speakers shied away from using the term. The first, Mark Shields, packed an MBA’s worth of material into his presentation on Advocate Physician Partners “clinical integration.” Shields is the senior medical director of the 3900-member physician-hospital organization, a mix of both independent and employed doctors in the Chicago area. The second, Tamarah Duperval-Brownlee, is the chief medical officer at Lone Star Circle of Care, a federally qualified health center in Austin, Texas, with some 50 physicians, seven dentists, and an assortment of other mid-level primary care providers. She described the clinic’s attainment of “patient-centered medical home” certification by the NCQA.
These two organizations diverge dramatically in their business models, their reimbursement arrangements and the scope of services they provide. But both use their information systems to drive adherence to quality measures, coordinate care within the group, and improve the overall patient experience. Both monitor performance and publish related statistics in a way that would be the envy of many a hospital. Both put clinicians at the helm. And both have made real headway in key outcomes, such as helping patients maintain their chronic disease conditions. Lone Star’s Senior Vice President Jen Berrera said the clinic strives for same-day access to its physicians, a policy which helps sidestep costly ED visits and avoid the expense of no-shows. For these organizations, it’s all about staying on top of what patients need, making sure they get it, and then letting providers know how well they are doing in upholding those goals.
It’s curious that these speakers shied away from describing themselves as an ACO. Perhaps they were thinking of the official Medicare program, whose massive final rules were announced just days before the conference. They indicated they would consider the federal program as a possible next step. To participate in the federal model, they’ll have to wade through a thicket of regulations, requirements and fine print. Advocate already participates in a variety of pay-for-performance programs with commercial payers—and it pushes back the same set of quality reports to all of payers, rather than trying to comply with different criteria from each payer, Shields pointed out.
In this tangled industry, simplification like that is always welcome. The result—coordinated care with improved outcomes—is not just welcome, it is now imperative regardless of which alphabet soup acronym applies. If I were a hospital executive, I think I’d pay a visit to Chicago or Austin to take at look at these operations. It might be as productive—or more—than poring through the 650-page ACO regulation and trying to figure what out to do next.
These two organizations diverge dramatically in their business models, their reimbursement arrangements and the scope of services they provide. But both use their information systems to drive adherence to quality measures, coordinate care within the group, and improve the overall patient experience. Both monitor performance and publish related statistics in a way that would be the envy of many a hospital. Both put clinicians at the helm. And both have made real headway in key outcomes, such as helping patients maintain their chronic disease conditions. Lone Star’s Senior Vice President Jen Berrera said the clinic strives for same-day access to its physicians, a policy which helps sidestep costly ED visits and avoid the expense of no-shows. For these organizations, it’s all about staying on top of what patients need, making sure they get it, and then letting providers know how well they are doing in upholding those goals.
It’s curious that these speakers shied away from describing themselves as an ACO. Perhaps they were thinking of the official Medicare program, whose massive final rules were announced just days before the conference. They indicated they would consider the federal program as a possible next step. To participate in the federal model, they’ll have to wade through a thicket of regulations, requirements and fine print. Advocate already participates in a variety of pay-for-performance programs with commercial payers—and it pushes back the same set of quality reports to all of payers, rather than trying to comply with different criteria from each payer, Shields pointed out.
In this tangled industry, simplification like that is always welcome. The result—coordinated care with improved outcomes—is not just welcome, it is now imperative regardless of which alphabet soup acronym applies. If I were a hospital executive, I think I’d pay a visit to Chicago or Austin to take at look at these operations. It might be as productive—or more—than poring through the 650-page ACO regulation and trying to figure what out to do next.