SO WHAT IS AN “ACO” ANYWAY?

Recently some of our patients (those with Medicare insurance and those employed by Mission Hospital) received a letter from Mission Health Partners (MHP), a newly formed Accountable Care Organization (ACO). The letter explained that Our Family Doctor (along with many other private practices in town) was joining a clinically integrated network called Mission Health Partners. As predicted, this letter raised more questions for patients than it answered. This blog post is an attempt to better inform our patients of what is happening in our community, try to explain what an ACO is, as well as dispel any false conclusions that may have been drawn from the above mentioned letter.

First of all, on the most basic level, the ACO is the logical extension of the PCMH (Patient Centered Medical Home) “team-based” care model that I wrote about back in 2013 in several blog posts on our website. What the PCMH care model has done for practices like OFD as far as improved workflows, outcomes and satisfaction for our practice population, the ACO model hopes to do for our entire community. These two major overhauls on “how” we deliver healthcare share three primary goals. In simple terms, these goals are: (1) improve quality of care for patients and populations (demonstrated by clinical outcome measures), (2) improve efficiency and reduce waste (eliminating unnecessary and redundant diagnostic testing) and (3) reduce the overall costs to the healthcare system.

As an ACO, Mission Health Partners is a collaborative alignment between independent private practices like Our Family Doctor, Mission Hospital, Mission owned practices, and the MAHEC residency program. Note this is a collaborative arrangement and not one of ownership. Our Family Doctor will remain a completely private practice and has every intention of remaining so for the foreseeable future. Please read this last sentence again to make sure you understand this. The formation of an ACO has nothing to with hospital expansion or practice acquisition. Practices like ours have decided to align with Mission Hospital through Mission Health Partners with the expressed goal of improving care for our patients. How will this quality improvement be accomplished you might ask? The simple answer is something that we all learned back in Preschool, and that is through “Sharing”.

Just like with other collaborative efforts, participants in Mission Health Partners will share Ideas. Things like “best practices” for tracking and treating chronic disease states (like Diabetes) and figuring out which strategies work best for increasing the use of evidence-based screenings (such as Colonoscopies and Mammograms). MHP participants will also share Resources. Ancillary services such as those provided by clinical case managers, clinical pharmacists and nutritionists are often cost prohibitive for single practices like OFD. These valuable services which can help us better serve our practice populations will become available to independent practices that choose to align with an ACO such as MHP. And finally, MHP participants will share Clinical Outcomes Data. Sharing clinical outcomes data will not only help raise the quality bar for all practices, but more importantly will help identify care gaps in populations. Through sharing clinical data, MHP will identify those practices or clusters of patients who need extra support toward achieving the three goals explained earlier in this blog post.

So who will be impacted by this ACO? The Mission Health Partners ACO will begin its work focusing on Medicare patients and Mission employees. In time, our community hopes that MHP will expand to serve the needs of Medicaid patients. In all likelihood, over time and as the program demonstrates success, it will expand to include other third party payers as well.

A couple of years ago when I would talk about PCMH to my colleagues and staff, I would say, “The PCMH is the care delivery model of the future, and the future is now”. With the evolving trends that we are witnessing in our country that focus on moving away from a “fee-based” model to a “value-based” model, the ACO is a big step in that process. There are ACO’s like MHP functioning at a very high level right now all over this country providing excellent population-based healthcare. “The future is now” comment certainly applies to ACOs now.

With the formation of Mission Health Partners, Asheville and the WNC region is joining other communities in changing the way healthcare is delivered in our country. For those practices like ours who have signed up to be part of this grand collaborative experiment, we have chosen to put our cynicism of “systematic change” aside and embrace the idea that improving the quality of care for our patients is worth the extra work that meaningful collaboration necessitates.

MICHAEL WEIZMAN, MD