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Crystal Run's ACO Puts Physicians in Driver's Seat

Margaret Dick Tocknell, for HealthLeaders Media, April 18, 2012

The physician group contracts with 4 hospitals in Orange and Sullivan counties, which are located about an hour northwest of New York City. It also contracts with an academic medical center in Westchester County as well as one in New York City.  

Crystal Run has for years been working on two parts of the popular "triple aim" for healthcare: better care and better health. The physician group's 15 sites are linked by a single electronic medical record system, and it has invested in patient care managers for more than 10 years. That hasn't been a reimbursable expense under fee-for-service arrangements, but Hines expects that with the ACO the group will begin to reap the financial benefits of having an established care management model in place.

Hines says cost, the third leg of the triple aim, hasn't been addressed because "frankly we haven't had to until now." He explains that there hasn't been a lot of Medicare Advantage or risk-based contracting in the group's service area compared to other parts of the county, but that's beginning to change.

Crystal Run will participate in track one of the MSSP. There is the potential for reduced revenues and reduced bonuses if the group doesn't meet patient quality and outcome goals.

The preparation and approach Crystal Run Healthcare is taking in developing its ACO sets it apart from the findings of the 2012 HealthLeaders Media Accountable Care Organizations Survey.

According to our survey of healthcare leaders, many remain uncertain about the value of ACOs to their organization, many are operationally unprepared for ACOs, and financial risk remains a potential stumbling block for ACOs.

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1 comments on "Crystal Run's ACO Puts Physicians in Driver's Seat"


Mike Barrett (4/19/2012 at 7:22 AM)
Looking at the list of the most recently approved MSSP contractors i.e. Medicare ACOs and even the Pioneer ACOs, one can see a distinct vein of physician leadership and engagement. What is coming to the forefront rapidly is the impact of physician exclusivity to a particular program and its effect on market share for specialists, PCPs, and ultimately IPAs, payors and other intermediaries and vendors to the ACO space. 3% of non MA patients are already assigned and as of July 1, this could jump dramatically an again on 1/1/2013. For example, in the MSSP "Primary Care Services" are defined by CPT code vs. specialty of the physician. This means any/every physician that signs on and who bills a 9921x is considered to have delivered PCP services and therefore backs in to exclusivity. This is reasonably straight forward for PCPs, it is another thing completely for specialists. To support an effort, that may not contain the specialists entire referral base, the specialist could invest into the ACO yet not sign a participation agreement. Counter intuitive, but possible and indeed probable where physician communities are more diverse. Their role on the BoD would be that of investor vs. provider. More interest comes in where the ACO is [INVALID]ing a vendor for a particular service - the PCP and now growing specialty exclusivity and consistency needs/demands/requirements changes the point of sale for many vendors. Stay tuned the MSSP program is just starting to reshape the landscape. mbarrett@ascendentcare.com