The Exec: 3 Questions With ACPNY's Paul Hebert on Value-Based Care

Advantage Care Physicians is 'ramping up' its approach to value-based care.

Healthcare providers are as unique as the patients they treat every day, and each has its own mission and singular approach to how it delivers care and Advantage Care Physicians (ACPNY) is no exception.

ACPNY is a downstate New York-based primary and specialty care provider servicing four of the five boroughs of New York City—Staten Island, Manhattan, Queens, and Brooklyn—as well as Western Long Island. With over 350 physicians and half a million patients, ACPNY operates under a patient-centered medical home model (PCMH). A PCMH model is a way of delivering high-quality primary care with greater emphasis on the patient using a "culturally appropriate, and team-based approach," according to the Centers for Disease Control and Prevention.

Paul Hebert is the Chief Administrative Officer for ACPNY, and he recently connected with HealthLeaders to discuss what makes the organization different from others and ACPNY’s approach to financial success.

HealthLeaders: What makes ACPNY’s approach to patient care unique?

Paul Hebert: I’ve been with Advantage Care Physicians for close to four years and before that, I spent all of my career on the payer side. I worked at Aetna for 21 years, and at United for 10 years in a lot of different financial and operational roles. So, when I came into Advantage Care, I asked myself, what is Advantage Care all about? Then I started to learn about their 'care for the whole you' approach and how we think about a patient individually. That is when it hit me that the single largest drink that Advantage Care brings to the table is that patient and provider relationship.

When I looked at this from a purely financial perspective and asked, 'how much does this cost?' and 'where do we see the benefits associated with that approach?' it was the persistency number that blew me away. If a patient comes in to see one of our providers, we maintain a relationship with that patient 96% of the time. We've curated relationships that are important to our patients. For example, we have a radiology provider in Lenox Hill Radiology on-site at most of our locations. We also have [lab test provider] Quest on site. We have curated relationships with hematology and oncology providers through our relationship with New York Cancer and Blood at nine of our sites. We have advanced dermatology at our sites. So, it's really simple and very seamless for our patients to move into specialties that their primary care doctor doesn’t offer, many times at the same location as their primary.

It’s a really wonderfully curated model around the most efficient and effective high-quality care delivery.

HL: What are your financial responsibilities as the chief administrative officer and what strategies are in place to maintain the organization's financial well-being?

Hebert: That’s an evolving answer. In the past Advantage Care had a lot of HMO patients on the primary care side and was paid capitation. The risk there is you see a patient often and you may not be covering your costs, but the advantage is if you have a healthy patient that’s coming in twice a year, you’re getting paid to provide that care and the services around it, so that can be financially beneficial to you.

The world has changed, and HMO products and capitation are dwindling. So, when we look at alternatives—and this has been an evolving process over the last four or five years, certainly started before I came but it's accelerated since I got here—we are moving into the value-based contracting world. We are moving into sharing risks associated with the care and the outcomes of that care for these patients.

We have roughly 300,000 patients that are under some form of a value-based care contract. Obviously, there are incentives if we can manage the cost of care while maintaining high-quality care that’s based on a series of measures. I always joke that if you've seen one value-based contract, you've seen one. They're always different. There are always attributes of some kind of MER [medical expense ratio] measure. It's certainly a quality measure, but it's the weighting of those quality measures and determining the gates that you have to clear to be able to be paid that share of the savings. So, we've really amped up our approach to value-based care. We've even reworked our compensation model for our providers to reflect those metrics and measures that fall under a value-based care contract.

HL: What has the outcome of this approach been?

Hebert: At first providers were a little apprehensive, but now that we’ve been incredibly transparent on what drives our financial results through reporting and score carding, [they have a better understanding]. There are discussions about our financial results with our leaders and physicians at least every month. I’m always getting questions from our physicians, and they come to me with ideas on what else we can be doing. Some ideas are great, and some are borderline crazy—but they’re always well-intentioned and provide good foundational thinking.

When you look at quality metrics, and an opportunity to close gaps in care, there are a lot of ideas around outreach and how we can get in touch with our patients, and how we can leverage all of the interaction points that we have with a patient, whether it's through primary care or even specialty care and now that we can capture all this in our EMR and Epic, it doesn't matter what position you are in ACPNY, you can see what's going on with a patient and you can start to talk to them about a mammogram, a flu shot, or a COVID-19 vaccine. Those reminders that pop up on the screen, now our call center folks can have those conversations too. So, it's kind of a cohesive strategy around continuing to educate folks on what they need to do to stay healthier.