MDNews - San Antonio

conditions and hospital readmissions. Incentives are based on their performance on these measures for specific patient populations. In the U. S., ma ny more practices are now practicing both fee-for- service care and value-based care models. The latter is the cornerstone principle around which ACOs are structured. THE VALUE OF ACOs Because the goals of value-based care are different from those of fee-for-service care, the structure through which care is delivered must be different as well. Traditional fee-for-service care prac- tices are designed to see a high volume of patients, while high-performing ACOs often collaborate with hospitals, have physician leaders focused on improv- ing performance, utilize sophisticated information systems, provide effective feedback to physicians and have embed- ded care coordinators. The U.S. hea lthcare market was not always focused on value, but the U.S. has a histor y of attempting to restructure hea lth care to decrease costs. Previous attempts to restructure ca re deliver y have included the hea lth maintenance organizations of the 1980s and 1990s and the Medicare Physician Group Practice Demonstration pi lot prog ra m in the mid-2000s. Costs continued to rise. In 2011, the U.S. Department of Hea lth a nd Hu ma n Ser v ices, v ia Med ica re prog ra m section 3022 of the Patient Protection a nd A f fordable Ca re Act of 2010, created ACOs in a n effor t to contain rising U.S. hea lthcare costs by helping physicians, hospita ls and other hea lthcare providers better coordinate care for patients. The term ACO has had many defini- t ion s . T he t er m "a c c ou nt a ble c a re orga nization" was origina lly used by Dr. Elliott Fisher and Glenn Hackbarth in 2006 during a public meeting with the Medicare Payment Advisory Commission. The Centers for Medicare & Medicaid Ser vices define an ACO as "groups of doctors, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients." In general, the ACO framework focuses on ensuring that all patients, especially the chronically ill, receive the right care at the right time. Since 2011, value-based purchasing contracts and ACOs have multiplied. As of 2017, there are more than 900 ACOs in the public and commercial sectors. In the public sector, the Medicare Shared Savings Program had nearly 490 par- ticipating organizations as of 2019. This program rewards providers who deliver h i g h- qu a l it y a nd low- c o s t c a r e t o Medicare patients. Similar contracts are being done in the commercial sector, such as Blue Cross Blue Shield's Alternative Quality Contract in Massachusetts. In both examples, providers enter into an agreement with an insurer to take on financial risk associated with the care and outcomes of specific patient popula- tions. Although the structures can differ, the goals are the same: increase quality of care and aim to reduce unnecessary healthcare costs. Impor ta nt to ACOs a re a focus on developing a shared mental model of care collaboration, data transparency and continuous improvement. Teamwork a nd collaboration a re demonstrated through care management and integrated ca re across dif ferent ca re locations. Organizations collect and share data on process and outcomes metrics via integrated health information technol- ogy, often a shared EHR. Teams use this data for continuous improvement using structured and standardized methods for improvement and continual self-auditing for improvement in goals. Most importantly, the success of an ACO hinges on practice engagement at a ll levels, especia lly in prima r y ca re. The reimbursements an ACO receives a re highly contingent on qua lit y a nd cost outcomes, which can be leveraged by a patient population that is adherent, loya l a nd enga ged in their ow n ca re. As a result, the longitudina l relation- ships patients develop w ith prima r y ca re clinicia ns a re of ten t he rea son patients adhere to medical advice (such as receiving a colonoscopy, seeing a clini- ca l psychologist, joining a weight-loss program or consulting with a surgica l specia list) as well as the reason they fol low up. Success i n t he Med ica re Shared Savings Program is contingent upon not only demonstrating va lue, but a lso on demonstrating patient attribu- tion through consistency of visits and utilization of resources within a single Medica re Ta x Identification Number. Fur thermore, it is of ten the frontline staff — schedulers, front desk workers, benefits coordinators, nurses and medi- cal assistants — who are interacting with patients and providing the initial patient experience. Therefore, on-site physician a nd sta f f enga gement in ma king key clinica l operations decisions a s they relate to ACO metrics is critica l. AT THE FOREFRONT UT Health San Antonio aims to be the leading ACO in central and south Texas. The organization is forming an ACO, the UT Hea lth San Antonio Regiona l Physicia n Net work, in July 2019. In doing so, it has worked to engage all its physicians and staff in a two-year process driven by physician leadership focused on the Triple Aim. "As a physician-led organization, we wanted to be sure a ll our leaders and stakeholders were involved in this pro- cess," says Carlos Rosende, MD, Executive Director of UT Health Physicians. " We c ont i nu a l l y e n g a ge a l l ou r medica l directors a nd clinica l lead- ers in our decision-making," says Bob Leverence, MD, Chief Medical Officer for UT Health Physicians. The focus on clinician and stakeholder engagement resulted in an enhanced, integrated patient care experience that builds on the practice plan's experience as a patient-centered medical home. Patients have their own personal primary care physician and can interact with their medical home virtually through an online portal, which allows patients the ability to see test results, medications and their visit histories. Another layer of personal care exists for ACO patients. "Our primary care and specialist teams and leaders helped develop workflows, which we use in daily interactions with 1 2

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