The Accountable Care Coalition of North Texas became Dallas-Fort Worth’s fourth accountable care organization (ACO) when the Centers for Medicare and Medicaid (CMS) announced 106 new contracts Jan. 10.
The roster of ACOs nationally nearly doubled with the announcement. ACOs offer hospitals and physicians financial incentives for better quality care and reduced treatment costs.
The Accountable Care Coalition of North Texas involves 70 local physicians and was organized by Houston-based Collaborative Health Systems (CHS), a subsidiary of Universal American, a Medicare Advantage and supplemental insurance provider based in Rye Brook, N.Y.
Universal American has 6,000 DFW beneficiaries in its TexanPlus Medicare Advantage plan.
Collaborative Health Systems added eight ACOs Thursday, bringing its total to 31 nationally. That represents about 14 percent of the nation’s ACOs. The company believes it is the nation’s largest ACO operator.
CHS uses nurses and social workers to coordinate patient care and provide clinical support for medical groups. It also employs an extensive information technology infrastructure and data analytics. It does employ physicians directly.
The company owns a 51 percent of each ACO and receives a share of the ACO savings bonus based on its ownership stake and other factors. It uses the one-sided risk model, which means it is not subject to penalties if it does not reach certain benchmarks.
Erin Page, senior vice president of market operations, said CHS plans to add 8-10 staff members to its existing Dallas staff of 17 due to the ACO.
The company’s expansion into ACOs is a logical because it already works with physicians to coordinate care with TexanPlus, Page said. CHS already works with many of its ACO physicians through that plan.
“Our physicians are highly engaged and see the changing healthcare landscape. Many want to stay independent and see this (ACO) model as a way to do so and deliver better quality care,” she said.
Page said one of the greatest challenges of operating ACOs is the data analytics.
“You have to take the (CMS) data and put it together like a puzzle to create reportable and actionable data for physicians. That’s not easy to do and it’s crucial to an ACO’s success. We were surprised by the amount of data that flows between CMS and ACOs. You also have to have a strong compliance setup because CMS is so focused on having ACOs follow the regulations. You also have to make sure doctors are adequately trained, understand the ACO’s value and how it can deliver better quality of care,” she said.
CHS also runs an ACO in Texas called Essential Care Partners that is composed of federally qualified health centers. The Los Barrios Unidos Community Clinic in Dallas is a part of that collaborative.
Plus ACO, a partnership between Texas Health Resources and Fort Worth-based North Texas Specialty Physicians, was formed in late 2011. Methodist announced its Methodist Patient Centered ACO in July. Baylor introduced its ACO, called Baylor Quality Alliance, in August.
Steve Jacob is editor of D Healthcare Daily and author of 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.