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Foundations for a Successful Patient-Centered ACO: First Steps. Frank E. Belsito, DO, MMM and James J. Dearing, DO, FAAFP, FACOFP. Evolving Healthcare. Moving from a “Sick Care” system to a “Health Care” system. A Time for Change. Health care is being delivered in a fragmented process

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foundations for a successful patient centered aco first steps

Foundations for a Successful Patient-Centered ACO:First Steps

Frank E. Belsito, DO, MMMandJames J. Dearing, DO, FAAFP, FACOFP


Evolving Healthcare

Moving from a

“Sick Care” system

to a

“Health Care” system

a time for change
A Time for Change
  • Health care is being delivered in a fragmented process
  • Lack of communication
  • Lack of coordination
payor paradigm
Payor Paradigm

System paid by what we do, not the outcome of what we did

Transformation from Fee-for-Service to Value-Based Payment:The Integrated Delivery System Perspective
value based strategy
Value-Based Strategy

Physician Alignment

Delivering Value

Demonstrating Value

Value-Based Contracting


Accountable Care Organization Anatomy refers to the

Structure of the ACO

ACO is not itself an entity, but rather it is a contractual relationship dealing with delivery and financial strategies and tactics between an Organized Delivery System and CMS-Medicare. It is also used to expand the relationship to other payors such as BCBS, etc.

We must first construct the ACO structure, creating the anatomy of the delivery system.


Creating an ACO and the payment systems to support them may well have the greatest potential for improving quality and controlling costs.

There is no single formula

for a successful ACO…..

so different approaches are encouraged


Integrating Hospitals and

Medical Groups

Hospitals & PO

Operate in a manner of a multispecialty group practice


governance structure all parties at the table
Governance Structure: All Parties at the Table

Assure that all parties are at the table from the beginning:

  • Hospital Administration
  • Physicians engaged in the ACO development
  • Others?
physician buy in
Physician Buy In
  • Be sure that all physicians understand what you are trying to accomplish, primary care first and then specialists.
  • Primary Care Physicians (PCPs) will use the patient centered medical home model.(Physicians must understand and identify with how the ACO will help their patients, accountability for care of the patient population.)
patient centered medical home pcmh seven principles
Patient Centered Medical Home (PCMH)Seven Principles
  • Personal physician for each patient
  • Physician directed medical practice
  • Whole person orientation
  • Care is coordinated and/or integrated
  • Quality and safety is ensured
  • Enhanced access to care
  • Payment reflects the value of care
patient centered medical neighborhood pcmn
Patient Centered Medical Neighborhood (PCMN)
  • Explain the differences between a PCMH and a PCMN. . .(Integration of specialist, hospital, home care teams, visiting nurses, and all other entities that go into managing the assigned patient population.)
recruitment of physicians the best and the brightest
Recruitment of Physicians:the Best and the Brightest
  • You need to recruit physicians whose quality parameters and patient satisfaction scores are high. Your ACO quality stats will be reviewed by employers, patients, and payors.
recruitment of physicians cultural fit
Recruitment of Physicians:Cultural Fit
  • It is critical to recruit physicians not just for their quality of care parameters but also for their ability to fit the specific culture of the ACO and the goals that you are trying to reach.
    • Make the group better by coming up with ideas from a potentially different angle.
  • The challenge is selling individualists on thinking as a team member and making decisions based on the “whole”.

Success will depend on:

  • Complete and timely information about patients and the services they are receiving
  • Technology and skills for population management and coordination of care
  • Culture of teamwork among staff
  • Coordinated relationships with Specialists
  • Ability to measure and report on the quality of care
implementation of an electronic medical record
Implementation of an Electronic Medical Record
  • All facilities need to be able to share patients’ medical records.
develop accountability of the group and assign a leader
Develop Accountability of the Group and Assign a Leader

The leader should have great quality parameters but will have to accept accountability for the team, not just his/her own stats.

use dashboards for accountability
Use Dashboards for Accountability
  • Every physician has a dashboard. Give them meaningful data: patient reports, productivity reports, and physician reports.
  • The brightest and the smartest will use that information to push your group in the right direction and make your ACO the most successful organization it can be.
  • There are a number of vendors to provide data.

Care Coordination

  • Case Management Coordinator
  • Disease Registry
  • PCMH
  • Health Coaches
  • Wellness Program
  • Care Transition Coordinator
infrastructure issues integrated care
Infrastructure Issues: Integrated Care
  • Coordination of both primary care and specialist doctors around the patient population (PCMH and Chronic Care Model)
  • List all patients in a registry by disease state and by all payors.
infrastructure issues cont d
Infrastructure Issues (cont’d)
  • Integrate patient registry with an electronic health record for both primary care and specialty facilities to enable exchange of info on patient real time.
  • Care managers embedded into practice sites to help manage chronic diseases/patients/issues in real time.
infrastructure issues cont d1
Infrastructure Issues (Cont’d)
  • Discharged hospital patients are seen by within 24-48 hours of discharge by their Primary Care Physician.
payment systems
Payment Systems
  • In an ACO fee-for-service does not work. Under the Value-based strategy you have to deliver quality. There is a transition timeframe involved in switching. The question is how do you weather the transition?
payment systems cont d
Payment Systems (cont’d)
  • Create a payment system that incentivizes team activities. All players should work to the highest level of their degree.
  • Put the work at the least common denominator degree.
  • Provide daily dashboards with the most information possible.

Clinical Integration is the

Core Initiative

Hospitals and Physician are turning to Clinical Integration to increase QUALITY and EFFICIENCY in care delivery.


Transforming care to significantly improve outcomes and resource utilization is MOREdifficult than achieving “clinical integration”!

negotiating with payers
Negotiating with Payers
  • Don’t try to cut deals with payers until you have your act and data ready for the negotiation.
  • Don’t just accept the payer’s data unless you can compare to your real data.