Don't Sit On The ACO Sidelines

Edited by Ken Congdon, editor in chief, Health IT Outcomes

Uncertainty regarding the long-term viability of ACOs has many healthcare providers taking a “wait-and-see” approach. Dr. Marlon Priest, CMO of Bon Secours Health System, explains why this is a big mistake.

The ACO concept has been described by many, including myself, as a grand experiment (See my earlier article from the May/ June issue titled The Great ACO Experiment at HTOinfo.com/go/aco). Furthermore, the press has been dominated recently by stories of ACO failures, including the mass exodus of several participants from the CMS Pioneer ACO Program. With all this in mind, it’s easy to see why many providers aren’t eager to throw their hats into the ACO ring. Many would rather wait and assess the results of this grand experiment before making the commitment to transform their organizational structure. However, Dr. Marlon Priest, CMO of Bon Secours Health System, believes this strategy is short-sighted. In this Q&A he illustrates the importance of being involved in the ACO movement from the outset.

Q: Why would any provider join an ACO today? Why not wait and see how the whole thing shakes out first?

Dr. Priest: For us, it’s an opportunity to fulfill the promise we made to the Medicare population in 1965 that we have not yet lived up to as a country. It’s an opportunity to help these patients manage multiple chronic diseases and navigate a complex delivery system so that they can spend their senior years in better health than they are today. For us, it was an organizational commitment to bring our communities to health and wholeness.

Q: What changes did you have to make to your organizational and communication structures to enable what you’re doing from an ACO perspective?

Dr. Priest: We have one ACO product that stretches across five states, from New York to South Carolina, and west to Kentucky. For us, the move to an ACO was a natural extension of our rollout of a single-platform, enterprise-wide EHR. It was simply the next step in our clinical transformation, which has focused on some very specific metrics regarding quality, safety, and cost per case.

However, we did need to communicate less. In other words, we had to move away from a holding company model and move rapidly toward an operating company model, which involved incorporating a great deal of standardization and automation into our infrastructure. For instance, we had to choose a set of metrics to collect and measure ourselves again in the first year. We also had to include our physicians practices, chief medical officers, and chief operating officers into a single conversation about how to coordinate care for the communities for this patient population.

Q: In your opinion, what are some of the advantages and disadvantages of joining an ACO today?

Dr. Priest: I think the big advantage is that you have an opportunity to go through the discipline of learning how to help patients coordinate their care. When you look at Medicare patients, they are a population in desperate need of care coordination — 75 percent of them have one chronic disease, and nearly 25 percent have two or more chronic diseases. Participating in the Medicare Shared Savings Program provides us with a data source from CMS that helps us decipher how to effectively coordinate care and build trust with this patient population.

The disadvantages of an ACO are that it will have a negative impact on your fee-for-service revenue stream because it will eliminate some care that shouldn’t be provided. However, the goal of the country is to move away from the fee-for-service reimbursement model anyway. I think the second disadvantage is that ACOs are still a big experiment. A lot of good and a lot of bad things can transpire as a result. Nobody is sure how ACOs will evolve going forward. That being said, it’s an experiment in which you have the opportunity to redefine the rules governing how we take care of patients.

Q: What has your experience been thus far, as part of ACO? How have you benefited and what have been some of the struggles?

Dr. Priest: I think our ACO involvement has given us a new shot of energy regarding a defined patient population for which we will have more data than we’ve ever had, and we have the ability to craft the necessary solutions to their healthcare problems.

I think the biggest struggle has been getting good, clean data from CMS. We received the download, but we’ve had to do some significant clean up. Another big struggle has been taking this work on while you’re still managing the majority of your patient population inside a fee-for-service model, where growth is measured in units of service delivered.

Q: What is your response to the negative press ACOs have been receiving lately?

Dr. Priest: Well, I think the press is failing the American public in this particular case. I know it sells newspapers, but I think we would be better serving our senior citizens in this experiment to push forward. We shouldn’t just examine the failures; we should focus on what we learned from these ACO failures and what we will do differently going forward.

Q: How do you think the ACO model will evolve or change?

Dr. Priest: I don’t know where the model’s going to go. There are some who believe the ACO model is time-limited, that after a while you squeeze out all the savings and that the shared savings model is going to run its natural course. That may well be true.

However, we’ve got an opportunity to improve cost and quality before the ACO model runs its course and move to some other form of capitated or bundled payment model. Holding the provider accountable for the outcomes of the patients who trust you is at the center of the ACO concept. You also need to give patients the freedom and right to move if a provider fails them. I feel these key elements will remain a focus for providers regardless of how the ACO model evolves in the future.

Q: What would your message be to those providers choosing to wait to participate in an ACO program?

Dr. Priest: Well, my first message is that if you have a better model to improve the care and the well-being of Medicare beneficiaries, please share with me, because I’d love to try it. My second message to them is that the water is actually a lot warmer than you’d think.

ACO participation provides you with all claims data for the patient population attributed to you. As a provider, you don’t have this data in most places. Bon Secours’ involvement in the Medicare Shared Savings Program instantly provides us with Big Data that helps us decipher how and where our patient populations are receiving care. We can use this data to make adjustments and help them better coordinate their care and navigate a complex delivery system. Ultimately, these efforts will help provide patients with more control over their own healthcare.