Independent doctors find success with physician-led ACOs

June 25, 2016

There are over 600 accountable care organizations (ACOs) in the United States-and half of them are physician-led.

There are over 600 accountable care organizations (ACOs) in the United States—and half of them are physician-led.

This approach is only gaining momentum, as the majority of physicians say they would prefer to stay in private practice and not sell to a larger entity. Providers are seeing that these programs are positioning them to better meet the changing expectations of patients.

Because physician-led ACOs are more flexible, providers can not only stay independent but maintain control over their mix of payers and the payment models they choose to support. Thus, an agile medical practice can manage risk and revenue potential by supporting a population of patients from a virtual ACO as well as a group of patients that are fee-for-service or even a direct primary care panel of patients. 

A shift towards a value-based and patient-centric practice will improve patient satisfaction and operational performance. By using a gradual, transitional approach, and testing new models on a smaller scale, a practice can offset the costs involved in fully transitioning to a single payment model, including staff downtime and reduced patient load.

Joining a physician-led ACO, as one piece of a bigger practice picture, has worked well for primary care physician Lee Peter Bee, DO, an internist in Sesser, Illinois, who says there were virtually no additional set-up costs. 

“There were some indirect costs with staff performing additional data entry for tracking the quality measures,” he says. “But there were no direct costs, and we have saved money and increased reimbursement through the group’s negotiating power.”

His ACO also has been successful in achieving the quality measures required to receive an incentive, so he has been receiving shared savings payments quarterly. In addition, Bee has tested a telemedicine model in his practice. So far, he has had the flexibility to keep the models and options that work and let go of those that don’t.

 

Family physician Douglas Hansen, MD, also has seen the benefits of participating in a large physician-led ACO and testing other reimbursement options at his practice in Littleton, Colorado.

“The focus is on certain high-risk groups of patients and previously uninsured patients,” he explains. “The payments coming in from the virtual ACO are small, but we are seeing that percentage grow and we are participating in some other value-based programs and receiving incentives through those as well.” He has also been trying some direct primary care options in his practice for patients with high-deductible plans.

To make these changes successful, the technology used to manage the practice needs to be up to date and support the risk stratification, care management and quality reporting needed to support a diverse set of payment models.

Technology is needed as well to support improved patient engagement through visit reminder, post visit surveys, and other tools. But both providers still find that some work remains manual, and as Bee mentioned, this is where some additional cost can come in to play.

As technology continues to grow to meet the needs of providers participating in value-based programs such as virtual ACOs, the process will only get easier. This will help the providers continue to be more efficient, improve outcomes and reduce costs. As a result, their incentives will grow. There is a lot of potential when independent physicians band together to achieve improved results as a group instead of standing alone. 

 

Tom Giannulli, MS, MD, chief medical information officer at Kareo, is a respected innovator in the medical technology arena with more than 15 years experience in medical software development. Follow him at @drtom_kareo.

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