Wichita groups vying to be first Accountable Care Organizations

07/28/2013 7:58 AM

08/08/2014 10:18 AM

With a deadline looming, several groups in the Wichita area are vying to become among the first Accountable Care Organizations in Kansas.

Accountable Care Organizations are those that obtain a designation from the Centers for Medicare and Medicaid Services and are yet another product of the Affordable Care Act. The goal of ACOs seems relatively simple: find ways to reduce the overall cost of health care while meeting certain quality standards set by Medicare.

The goal is to create more “coordinated care,” which means that Medicare patients get care at the right time and avoid duplication of services, such as X-rays or lab work.

Groups that succeed in cutting costs and meeting quality standards will share in the savings with Medicare, according to CMS.

But the trick is figuring out how, and area groups who are applying have differing strategies – from new electronic medical record systems to population health management – to try to cut costs.

“The whole philosophy is to structure the delivery model around the needs of the patient over the needs of the providers,” said Marlon Dauner, whose company, Health Dimensions, manages Specialty Independent Practice Association of Kansas and the Physician Alliance of Kansas.

The Physician Alliance of Kansas, a 231-physician network consisting of Wichita-area primary care physicians and SIPAK physicians, formed last fall and is seeking to become an ACO. Among the strategies employed by the alliance: better integrate more electronic health records so that information can be readily shared among doctors.

“In 2010, there was a lot of discussion around Obamacare with initiatives in the federal government and health care providers to be responsive to the goals of ACA,” Dauner said. “It resulted in a number of Pioneer ACOs. ... A number of independent physicians (locally) wanted to find a method to be responsive to the Affordable Care Act initiative and maintain their independence as separate practices and not being employed by a larger system.”

To participate, groups must have at least 5,000 Medicare beneficiaries. Applicants who are accepted into the Medicare Shared Savings Program will enter into a three-year contract with no risk, Dauner said, and can split any savings 50/50 with Medicare.

After three years, they can leave the program or enter into another with increased risk.

Applicants for this round will know if they are accepted in the fall.

Dauner said the alliance doesn’t currently have a projection for the amount of potential savings. He said there’s an opportunity to save significant dollars, but that’s not the motivation.

“The physicians can make more money off of their services than off of shared savings,” Dauner said. “The objective is to try to improve the process, save money for the system, so we can continue to have a system that functions for people here and around the country.”

“No one is going to get rich off of Medicare savings,” Dauner said. “Some of the benefits of the ACOs are to improve care coordination of patients, improve communications among physicians, and the care transition as they move from one physician to another and one setting to another to make sure the patient doesn’t get lost in the cracks somewhere.”

For the past year, Kansas Medical Center, which is owned by about 40 physicians, has also planned to apply for ACO status.

“I don’t think there’s any real question that Medicare is broken at the moment, and it can’t exist the way it’s going now forever, and this is an attempt to fix it,” said Malik Idbeis, business development manager for Kansas Medical Center. “Whether it’s the right solution, we’re not sure. But we’d rather start working now than jump in halfway through and be behind the game.”

Not all of the 40 physician investors are participating in the ACO, Idbeis said, but there are additional independent physicians who are.

Although there are a lot of unknowns, the ACO is working to implement more electronic medical records and increase communication among physicians.

“KMC has, from the beginning, been about empowering physicians. Using our experience, we believe (Kansas Medical Center Partners ACO) is an excellent position to allow physicians even more, unhindered control of the healthcare decisions for our patients,” said Dr. Badr Idbeis, Kansas Medical Center CEO, in an e-mailed statement. “Strong communication has been front and center from the start, and those lines of communication and trust amongst providers will be vital to the well being of our patients and to the success of the ACO."

Malik Idbeis said most groups pursuing ACO status are interested in the Medicare Shared Savings Plan since there’s no risk, other than investing the time and money into the technology.

“It’s a way to get your feet wet without diving head first,” he said. “There are going to be IT challenges, but it’s going to help get everything working together, to see the whole picture of the patient instead of just a little bit. ... A lot of it will be communication and cutting down on duplicate orders. It’s just going to be more efficient.”

Via Christi has been talking about becoming an ACO for more than a year, but Ed Hett, family physician and medical director for new models of care for Via Christi Health, said the real drivers for the decision to apply now included Via Christi’s ability to hire someone with experience in ACO development. Also, Via Christi saw others in the community moving in that direction.

“We thought the market was ready at this time,” Hett said.

Via Christi is also putting in an electronic medical record system next April that will help coordinate patients across its entire system, Hett said.

But Hett is not projecting huge profits.

“We’ve been telling clinicians all along that if we’re in this to make money at it, it probably won’t happen,” Hett said. “Across the country, ACOs for the most part have not had any shared savings come back to them. It’s happened in some small pockets, but not large amounts.

“The real strength of ACOs is utilizing and coordinating care and preparing for the curve to being compensated (by Medicare) for quality outcomes based around the needs of patients.”

Via Christi’s ACO will include about 400 employed physicians and mid-level providers as well as participating community providers. Patients should be minimally impacted, Hett said, and will still maintain their choices for such things as getting their imaging sonograms done where they want.

In addition to using electronic medical records, Via Christi’s strategy is to work on population health, using its Healthier You program for employees and its Advantra program, a pilot Medicare insurance program in partnership with Coventry Health.

“What we’ve been trying to do is work with population study data to see problems and develop programs that address those,” Hett said.

“What we’re going to do is move those pilots into the ACO with the Medicare Shared Savings Plan. In order to do that, we need at least 5,000 Medicare patients established with a primary care physician. We have around 27,000 Medicare patients that call us their physicians.”

With the trend of hospitals having to meet certain quality measures to earn full reimbursement from Medicare, Hett said Via Christ is excited to work on the ACO at no risk before it becomes a more “onerous environment.”

All of the groups agreed that ACOs likely won’t be the end-all, be-all for cutting costs for Medicare beneficiaries.

“I don’t know where all the ACO activity will lead, but more importantly the landscape for health care delivery and financing is changing and that will continue,” Dauner said.

“Regardless of whether ACOs are the final structure, which I don’t think they will be, I think we can be assured things are going to change and health care is going to become more retail in nature, and people will have a lot more input into their care.”

Pioneer ACOs

Earlier this month, the federal CMS announced the results of some of the first groups to test the ACO model.

The cost for more than 669,000 beneficiaries within Pioneer ACOs grew by 0.3 percent in 2012, while the cost for similar beneficiaries grew by 0.8, according to a news release. Additionally, 13 of the 32 Pioneer ACOs had shared savings with CMS with gross savings of $87.6million in 2012 and savings of about $33million in Medicare Trust Funds.

For quality measures, CMS reported that all 32 Pioneer ACOs earned incentive payments for achieving the maximum reporting rate for the first year. Some of the quality areas being measured include readmissions, blood pressure control and cholesterol control for diabetes patients.

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