Plus ACO, an accountable care organization partnership between Texas Health Resources and Fort Worth-based North Texas Specialty Physicians (NTSP) is more than halfway through its first year. The ACO, awarded by the Centers for Medicare and Medicaid Services in December, was the first in North Texas and one of just 32 nationally under the Pioneer ACO model.
NTSP, which serves patients in Tarrant, Parker, and Johnson counties, has more than 10 years of experience in population health management and has participated in quality initiatives tied to financial incentives. It cares for about 30,000 Medicare Advantage patients—including 25,000 in UnitedHealthcare’s Secure Horizons plan and about 5,000 in its wholly owned Care N’ Care plan. Plus ACO will have 19,000 patients who will be enrolled in the traditional Medicare plan.
The physicians’ group has more than 600 physicians, a quarter of whom are primary-care physicians.
THR has been a primary participant in NTSP’s health information exchange (HIE), known as SandlotConnect, which allows providers to share patient data electronically. Sandlot, its more informal name, is the largest HIE in Texas. More than 2,500 providers use the Sandlot portal and more than 400 physicians feed their EMR data into the system. Likewise, 15 of the 30 hospitals using Sandlot also feed data into the portal.
Sandlot is a critical component of the ACO strategy of being able to prove cost savings and quality. The ACO is creating quality and cost data during the first year of operation to be able to show improvement and cost savings in the second year and beyond.
Plus ACO has spent most of the past few months communicating with local healthcare providers and patients. Natalie Wilkins, Plus ACO director of operations, said the ACO conducted separate campaigns for physicians and patients. NTSP used its standard physician network communication channels and group meetings to explain the ACO. Patients received emails and phone calls. The ACO also used radio advertising to create awareness.
Dr. Stuart Pickell, an internal medicine physician and Plus ACO board member, said he tries to defuse the ACO link with “Obamacare” for patients by explaining that it grew out of a Republican idea advocated by Newt Gingrich.
“Some people think it’s an HMO. It’s not. People join HMOs. When doctors agree to join ACOs, their patients become ACO patients. Many people don’t know they are in an ACO. But there are no restrictions. It’s still Medicare,” he said.
Wilkins said data analysis found that about 10 percent of the ACO patients had no PCP and were seeking only specialists. Part of the communication campaign was to contact those patients and recommend PCPs to them. She said the most effective way to explain the ACO was to do so in physician offices.
“If you break down the explanation into simple terms—that it is a partnership to improve patient outcomes—most were positive about it,” she said.
The ACO is continuing to mine its claims data for efficiencies to establish quality priorities.
“It is challenging to take millions of (patient) records and turn them into actionable data,” Wilkins said.
A key goal for the organization is to improve care coordination. It is using Gordian Health Management of Fort Worth for case management of its ACO patients. Transition nurses will coordinate discharges from the hospital to home, long-term care or skilled nursing facilities. NTSP also embeds three care logistic managers in high-traffic physician offices as a pilot project to coordinate care.
According to a recent Commonwealth Fund survey, fewer than one out of three hospitals engaged in ACOs use population-based management approaches to target high-risk patients. Only one out of five said they use predictive tools to identify high-risk patients who are likely to have poor health outcomes or have high resource use.
Wilkins calls case management “the glue of the ACO.”
An ACO is a collaboration of healthcare providers who accept the responsibility for the cost and coordination of its patients. The financial incentive emphasizes quality, efficient care rather than quantity of care. If the ACO succeeds, its members receive a financial bonus. If it fails to meet its goals, the members may be penalized financially.
Pioneer ACOs will be eligible for larger bonuses than those in the Medicare Shared Savings Program, which were created in April. However, they will be at risk to pay Medicare substantial financial penalties if they accelerate spending growth. Pioneer ACOs would not be at risk during the first year. CMS hopes the savings in the Pioneer ACO initiative will reach $1.1 billion over five years.
The Pioneer ACO model was created specifically for organizations with a track record of managing financial risk and developing systems for being accountable for quality-related performance.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at firstname.lastname@example.org.