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Our exclusive interview with a physician leader involved in the CMS Shared Savings Program reveals what she hopes to achieve through the program. Could your practice learn from her experience?
A primary care physician (PCP) leader of an accountable care organization (ACO) is confident about succeeding in the Centers for Medicare and Medicaid Services’ (CMS) Shared Savings Program, she tells Medical Economics eConsult in an exclusive interview.
CMS announced last week that it had selected 27 ACOs to participate in its Shared Savings Program, which rewards the organizations for meeting healthcare quality benchmarks and reducing costs. One of those ACOs is Primary Partners LLC, a Florida-based, primary care-owned and -managed group made up of independent PCPs in Lake, Orange, Osceola, and Polk counties. It is expected to serve about 7,500 beneficiaries.
Cara Jakob, MD, a family physician, is Primary Partners’ clinical integration director. After the CMS announcement, she responded to an emailed list of questions from eConsult. She explained why the doctors formed the ACO, what they hope to achieve, and why they chose the Advanced Payment Model of the program, which provides the ACO with upfront funding to assist with costs (answers have been edited for length and clarity).
eConsult: Why did you join CMS’ Shared Savings Program?
Jakob: The impetus to enact change came from an office visit with a long-time patient of mine who has a debilitating muscle-wasting disease. This patient, who is a Medicare beneficiary, asked me what would happen when she is unable to come to the office to be seen anymore. She does not have long-term care insurance, and she will fall through the current gaps of care in the system. I thought to myself, I would like to be able to make a home visit, but I just don’t have the time. Will she have to go to the emergency department by ambulance? This will raise the healthcare costs. This was when I realized that the fee-for-service model of CMS needs to change and the possibilities the shared savings model brings. I joined in the discussions with [Medical Director] Memory Crowley, DO, and a dedicated group of [PCPs] who also share similar patient concerns.
As a result, we formed Primary Partners LLC, a [PCP]-founded, -owned and -managed ACO that is different than many other models. Our mission is to provide clinically integrated, excellent quality patient care while continuing in our independent practices. This mission aligns perfectly with CMS’ goal of improved individual patient care and improved population care at a decreased cost. All primary providers and CMS share in the savings, and patients receive improved care.
eConsult: Why are you qualified to succeed in the Shared Savings Program?
Jakob: Our physicians and leadership bring combined experience of more than 30 years in the medical and regulatory arena. We have an incredible partnership with our local specialists and hospitals. Our collaborative model not only includes the hospitals, but also the subspecialists and will extend to all healthcare services.
Every Medicare beneficiary we have spoken to is excited about the ACO. Two committees led by our Medicare beneficiaries help run the outreach and patient education programs.
eConsult: Why did you choose the Advanced Payment Model ACO?
Jakob: The Advanced Payment Model allows Primary Partners-as a [PCP]-based ACO-to start building and investing in healthcare [information technology] (HIT) and care coordination. Without it, we wouldn’t have access to capital to participate in the program. This allows us to integrate our ACO patient population, coordinate care, produce quality metrics, and design and launch education and patient outreach programs that meet our patients’ needs.
eConsult: What were the most significant changes your participating practices made to join the ACO?
Jakob: The experience and changes vary from office to office, but opening the lines of communication is a significant change our participating practices have made to join the ACO. We worked as a collaborative team to develop, vote on, and approve clinical protocols and to meet CMS’ ACO requirements to submit our application. Sharing experiences and expertise across the ACO with our specialists and hospitals has been very positive.
eConsult: What will be the biggest challenges?
Jakob: HIT costs, implementation, and having patients become active partners in their own healthcare are going to be some of the biggest challenges.
Technology allows us to re-engineer the way we operate as an ACO. This means educating our providers and patients to help them fully use technology as a tool to support clinical integration and to coordinate care throughout our ACO network. This is key to providing the entire continuum of patient-centered care. We are excited about the opportunity and are planning a phased implementation, training, and educational approach to manage our HIT transformation.
eConsult: What will be the greatest benefits?
Clinical integration is going to provide the greatest benefit for the organization to achieve the triple aim of improving individual patient care and the care of the population and lowering healthcare costs.
Clinical integration will provide improved patient care through communication among providers and all services. We have already seen this benefit in the short time the physicians have been clinically integrated, both in the writing and implementation of clinical protocols and in the simple act of taking the time to meet. All physicians are extremely busy these days, so this level of communication has decreased as a result, and the ACO increases communication. In addition, clinical integration adds another level of clinical expertise and promotes sharing best practices.
Clinical integration will lead to healthcare savings by putting standards in place that will allow for monitoring and limit over-utilization of services. Patients’ care needs are being put first instead of the healthcare system, which is leading to cost savings. The cost savings are being shared between CMS and the physicians, so they are being rewarded for providing excellent quality care and taking the time for clinical integration.
Clinical Integration allows us to improve the health of the population by looking at the highest expenditure and high-risk disease states, such as diabetes and congestive heart failure, and implementing protocols to effect change in these populations. For example, by converting a high-risk patient with multiple medications-the patient with diabetes who does not understand why he needs to take his medications or watch his diet because he feels better with an uncontrolled blood sugar-CMS and Primary Partners can then share the savings of the avoided myocardial infarction or stroke or blindness. The patient is able to continue to live productively and independently.