Primary Care, Coordination Drive Accountable Care Organizations

September 06, 2016 - Within the new value-based care payment strategies being developed among healthcare providers, payers, and government agencies, accountable care organizations (ACOs) continue playing an important role in bringing greater quality improvements and reimbursing medical facilities based on value instead of the quantity of services. Primary care physicians are currently holding a major position within accountable care organizations especially with regard to care coordination.

The importance of primary care among ACOs

The company Aledade is one that is forming partnerships with primary care physician groups to create more robust accountable care organizations. Several weeks ago, Aledade announced that it had formed a primary care physician-led Accountable Care Organization (ACO) in Arkansas, which is supported by the Arkansas Foundation for Medical Care.

To gather more information about Aledade’s Arkansas ACO, HealthPayerIntelligence.com spoke with Dan Bowles, ACO Executive Director at Aledade, Inc. Bowles had direct experience managing the Arkansas accountable care organization.

When asked what steps his accountable care organization took to structure itself around primary care, Bowles answered, “I can speak both in relation to some of the newer ACOs that we’ve launched but also all of Aledade’s ACOs. The central tenet behind our approach is primary care led and primary care led physician ACOs are really the ones who have the best alignment of interests and incentives across the healthcare system.”

“I would say that the overwhelming majority of the physicians who are in our ACOs are primary care physicians. We really do everything we can to build our structure around the primary care practice,” Bowles added.

The move toward creating accountable care organizations came from the Affordable Care Act and the federal government’s push toward establishing the Medicare Shared Savings Program (MSSP). The most recent results from the MSSP program show that its ACOs were able to garner $466 million last year. From 2012 to 2015, the Medicare Shared Savings Program was able to save a total of $1.29 billion for Medicare.

The building blocks of ACOs

The government stimulated the creation of accountable care organizations between private payers and providers over the last several years. More and more ACOs have been forming in recent years outside of the Medicare Shared Savings Program, according to a study conducted by Leavitt Partners and the Accountable Care Learning Collaborative. How do partnering companies create these entities? Bowles provided his perspective on the first building blocks of accountable care organizations.

“Aledade’s Arkansas ACO, in terms of launching construction, really started with our partnership with the Arkansas Foundation for Medical Care,” commented Bowles. “They are a fabulous organization based out of Little Rock that’s been doing some more quick practices for quite a long time in this healthcare transformation and value-based care arena.”

“Collectively with them, we identified a number of primary care practices across the state over the course of the last couple of years. We’ve worked to establish partnerships with those practices that are really focused on making improvements not only on practice level workflows but also with regard to broader healthcare system care coordination to really try to advance patient outcomes and reduce total costs of care in the context of the ACO,” Bowles continued.

“To summarize, it started with the Arkansas Foundation for Medical Care and our partnership there. That really opened the door to a number of practices in the state who were like-minded and allowed us to start putting the building blocks together.”

The Medicare Shared Savings Program

When it comes to choosing which health payer to partner with when creating this accountable care organization, Aledade went with the public payer - the Centers for Medicare & Medicaid Services - by operating through the Medicare Shared Savings Program. One of the key achievements that the organization has gained is its large care coordination enterprise, noted Bowles.

When asked about the  type of relationship the Aledade ACO has with its payer, Bowles replied, “The ACO today is in partnership with Medicare, CMS, and the Medicare shared savings program. All of the practices are participating in the MSSP. We are actively engaged with discussions with other payers in the state around different ways to collaborate and work together, but today, we’re working only in Medicare.”

“In terms of the challenges we’ve overcome or some of our big wins in terms of milestones, I would say a big one has been in trying to identify different ways to coordinate with other provider organizations in the healthcare system. We’ve got a partnership for data exchange with Baptist Health, which is the largest health system in the state. We’ve also partnered with SHARE, which is the health information exchange for the state,” added Bowles.

“That’s really allowed our providers to get access to information on discharges and other hospital-based episodes that their patients may encounter. In terms of working with the payer specifically in the MSSP, the access to the claims data in a more comprehensive format has really given the providers access to information that’s vitally important to delivering better and more coordinated patient care,” Bowles pointed out.

Quality metrics among ACOs

An important aspect of running a successful accountable care organization is measuring the quality of care provided. This may include following HEDIS quality measures as well as other important factors as part of the EHR Incentive Programs.

When asked how the Aledade ACO measures quality of care within its provider network, Bowles explained, “There are a number of quality measures that are specific to the Medicare Shared Savings Program several of which are clinical in nature and others are more claims-based measures. The measurements are really being taken directly through technology interfaces such as EHRs.”

“All of our ACOs including our ACO in Arkansas are EHR agnostic. Provided that the system is meaningful use certified, we’ll partner with a practice that is on any electronic health record and we’ll build an interface there to access that data and help assess various quality measures,” he continued.

“With respect to some of the other data points that we’re working with the various practices on, a lot of it begins and ends with the claims data. That gives us good surveillance into various quality metrics and allows us to put together data-driven and evidence-based protocols that allow for better patient care and improved quality measures,” he added.

Bowles' final point delves into how the Arkansas ACO is gearing itself toward strengthening primary care among the Medicare beneficiaries they serve.

“What we’re trying to do is offer a new model of primary care,” he concluded. “In our model, we try to get primary care doctors to focus on delivering high quality care and do what’s best for their patients while we take on more of the bureaucracy and paperwork. That kind of looks like a partnership with these primary care practices to build and lead ACOs so that these physicians can stay independent and really practice medicine the way they’ve always wanted to.”

Dig Deeper:

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