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Accounting for Independent Physicians

Philip Betbeze, for HealthLeaders Media, June 13, 2011
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The ACO, at this point, focuses only on Medicare Advantage patients in order to test and figure out what tactics work best to improve a population’s overall health. Strauss explains that the ACO’s 11,000 patients have an existing relationship with both Summa and the physician practices in the ACO. The ACO essentially is paid under a capitated model that brings in about $80 million in revenue per year, regardless of the interventions the population may need over that time period. 

“So we’re at risk both clinically and fiscally for the health of those members,” he says. “As we generate appropriate savings based on quality and HEDIS measures, we can create pools of savings to incent physicians.”

A new structure

One of Strauss’s first priorities in creating an ACO was hiring someone who got the concept and who had a track record of building an accountable care model. Michael Hillman, MD, was that person for Strauss. Hillman is Summa’s chief medical and quality officer, and his key role is in reaching out to independent physicians in Summa’s service area to encourage them to join the ACO. A neurologist, Hillman developed his accountable care skills during his years at Marshfield (WI) Clinic, an all-ambulatory health system that also owns a health plan.

“We designed Marshfield’s group practice initiative with CMS,” he says, “before anyone really knew what an ACO was. It made economic as well as patient sense.”

Marshfield’s initiative included an EMR and call center strategy that provided patients 24-hour access to care. They might not be able to see their doctor at all hours, but the point was to provide expert medical advice to patients with severe or chronic illnesses in part in an attempt to save them unnecessary and—costly—trips to the emergency department. It evolved into a program that reduced hospitalizations for all causes by about
30%, according to a study funded by the Agency for Healthcare Research and Quality.

That experience gave Hillman a certain credibility with Akron-area physicians when he arrived in September 2009, but a formidable challenge was alleviating fear from independent community practices about working as a partner with a hospital-centric system.

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