Torrance, California-based HealthCare Partners Medical Group was one of 32 accountable care organizations chosen to participate in CMS' Pioneer ACO Model on December 19, 2011. Additionally, HealthCare Partners, which manages and operates medical groups and affiliated physician networks in California, Nevada and Florida is part of a commercial PPO ACO with Anthem and is working with other insurers on ACO agreements.
HealthCare Partners' Corporate Medical Director Tyler Jung, MD, reflects on some of the successes and challenges of being in an ACO. He also offers advice for healthcare executives working with medical groups in ACO arrangements.
Question: What have been some of the most notable successes of your ACO?
Dr. Tyler Jung: I think just getting started and converting the mindset of a traditional fee-for-service provider into one that is rigorously measured on quality and value. It's kind of an intangible success — it's easy to say you'll do this — but to actually start doing it, to me, is a success.
For example, we've been able to set up programs for when Medicare patients are discharged from hospitals. We have health coaches and care managers calling these patients and ensuring they are being seen in a primary care physician office. We're connecting patients to their follow-up appointments; we're coordinating care of patients being discharged from hospitals and skilled nursing facilities back to outpatient care. We are getting into the transition of care aspect for this subgroup of beneficiaries.
For our Pioneer ACO beneficiaries, we haven't yet definitively measured whether there's scientific proof that transition care assistance is reducing utilization. We know it’s a patient satisfier and, in our own managed care experience, we have reduced readmission rates by simply making sure patients see primary care physicians after discharge. At HealthCare Partners we have a number of coordinated care programs that have allowed our patients to receive local and nationally recognized quality care.
Q: What have been some of your biggest challenges as an ACO?
TJ: Just getting others familiar with the concept of accountable care and spreading the message of transitioning from a fee-for-volume world to a world where quality, efficiency and cost are important. It's adapting to the triple aim — providing better health for the patient and for the population at a lower cost.
Probably the biggest challenge is translating those simple concepts on a chassis that has traditionally been a fee-for-service, fee-for-volume kind of chassis; it's a whole dictum of change of care.
We've gone out and talked to our hospitals about that kind of change. They understand the changing healthcare environment and many aspects of the ACO Model. We also work with individual primary care physicians and specialists and explain how traditional fee-for-service Medicare is changing. Most physicians recognize how quality measures and utilization costs are increasingly measured and matter more than ever now. That's probably been one of the largest global hurdles to climb, spreading the message and importantly going into the early implementation phase.
Another challenge has been ensuring our Medicare ACO physicians’ patients are identified when they go somewhere for care. When we work with private health insurance plans, we quickly know who those Medicare Advantage and managed care members are and we onboard them and educate those patients about the clinical and educational programs we offer. These managed care members get an orientation package and ID card that indicates they are part of HealthCare Partners. They are easily identified and cared for no matter where they go.
In a Medicare ACO, physicians’ patients are not necessarily oriented about the program elements of their care and they do not have an ACO-Healthcare Partners card. They just carry their Medicare card around. If they end up at an urgent care hospital or a skilled nursing facility, they are not going to say 'I'm an ACO member, treat me differently and provide me coordinated care.' Most of the time they will fall under the prevailing care strategy of a fee-for-service world.
Q: How has the relationship been with your partnering hospitals?
TJ: I think it has been a work-in-progress, but once we sit down with all our hospitals we recognize we have common ground. Some of the hospitals are concerned — the simple discussion is that if we manage these populations, we will have fewer patients in the hospital.
As the conversations have matured, hospitals understand that, regardless of whether it's an ACO, healthcare changes are occurring. Working with hospitals to prevent preventable admissions is important and they understand this is where the puck is going. They understand this is good for patients, good for communities, good for their primary care networks and where successful hospitals are migrating to.
All in all, it's been a work in progress, but once we have good conversations we find strong common ground and can work together, particular on discharges and readmissions. Hospitals do not want patients to fall through the cracks — they don't want the care that's occurred in their hospital setting to unravel. So, they are participating with us in trying to coordinate care for patients, increasing quality metrics and eliminating waste.
Q: Do you have suggestions for hospital executives working with medical groups in ACO arrangements?
TJ: I think the hospitals of tomorrow are going to have to be all about quality and efficiency. Those two drivers are going to be important for healthcare cost containment and high quality. Aligned incentives will drive better quality and costs for the entire delivery system and result in financially stronger and more efficient hospitals.
Hospitals also need to assist coordinating discharge, making sure the beneficiary has the best possible chance to remain out of the hospital after discharge, making sure medications are set, and with other coordinated care activities.
Hospitals understand that these are some of the major strategies in managing ACO patients.
Q: How has the relationship with CMS been thus far?
TJ: Overall, it's been great. We certainly have learned a great deal about how this is done; it's different than working with our usual local health insurance plans, or even national ones.
CMS has set up several working groups that HealthCare actively participates in. These include: Data Analysis, Population Health, Beneficiary Engagement, Provider Engagement, Pharmacy Care Coordination, HIT, Safety Net/Medicare and Medicaid Beneficiaries.
CMS has many different guiders and they have to be internally consistent across the nation. The ACOs participating organizations draw upon different experiences.
CMS has been very responsive. They've assigned us a program officer, a singular contact at CMS and they are passionate about making swift progress. I think we've been overall pleased. Also, they've provided us data on patients, and we're combing through that data to understand our patient population allowing us to focus on the most critical clinical and cost areas where we can make a difference.
They have the Pioneer ACOs sharing best practices and are working closely with us to optimize the Pioneer ACO program in year one.
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