MDNews - Greater Boston

helping to produce millions in surplus savings since its inception. The model is ideally suited to self-funded groups — and Brough should know because he has led a number of them throughout his career: Physicians of Cape Cod Accountable Care Organization (ACO), an original Shared Savings ACO selected by the Centers for Medicare & Medicaid Services and one of only two original Shared Savings ACOs to take both upside and downside risk; Health Net, Inc., the largest physician- and hospitalowned managed care network in Maine; and Yale Preferred Health, Inc., an HMO that achieved significant growth under his leadership. Brough started in the 1970s, advancing from director of underwriting at New England Mutual Life Insurance Co. to major accounts underwriting officer at BlueCross/BlueShield of Illinois to vice president and chief financial officer at Central Massachusetts Health Care, Inc. He is a graduate of the College of the Holy Cross, holding a Bachelor of Arts degree in economics, and he received an MBA from Anna Maria College. He has completed advanced management and financial education at the Wharton School of Financial Management (HMO program), and Northwestern University's National Management program. Following the trajectory of consumerdriven health care, in 2010 Brough developed a corollary program to Pinnacle Preferred Providers that centers around the patient. The program, Pinnacle Perks, uses healthcare smart card technology to create a secure personal health record for the patient. This personal health record can be shared with other providers in the Pinnacle Perks program, thus improving quality by sharing consistent, physician-updated data. Brough's research in developing the Pinnacle Perks program showed that many national health systems in Europe and the Far East use healthcare smart card technology to handle their data needs. To engage patients, Brough added a point system, which provides rewards to patients for using their Pinnacle Perks card. "We reward people for using our program, which can improve the quality of their care," he says. Patients in the program can redeem their points at the company website, www.pinnacleperks.com. Patient membership in the Pinnacle Perks program is free and open to everyone, regardless of health status or insurance program. Since the program was introduced, its popularity has soared. Membership includes Shannon Miller, America's most decorated gymnast and gold medal winner. Preferred Providers participating in the Pinnacle Perks program include Shields MRI, Bayada Home Health Care, Gentiva, and New England Baptist Hospital and its physicians in Boston. More recently, the Pinnacle Preferred Providers program, as well as the Pinnacle Perks program, was written into the Medicare Shared Savings ACO application and contract by name. The Pinnacle Perks program helps address the requirement for "patient engagement" under the federal contract. As one of the early adopter ACOs, the entity has been in a contract with Pinnacle Perks since its April 1, 2012, inception date with Medicare. "We are delighted that we are part of an accountable care organization program through the Centers for Medicare & Medicaid Services," Brough notes. "It is great to be a part of the innovation that will lead to greater patient empowerment and improved quality." Brough is bullish about the future of Pinnacle Health. "We will continue to look for opportunities to innovate in the new healthcare environment," he says. "Many changes will take place throughout the country as the new federal healthcare legislation takes hold. The old way will not be the new way. "With the focus on the patient, there will be a power shift. In the past, insurance companies, hospitals and physicians have been the power brokers. The new world will require everyone to earn the business and respect of the patient, much in the same way other industry sectors have to earn their customer base. "The patient will eventually decide where the true value lies, as we transform out of a complex and confusing healthcare system that many people don't understand. "It's an exciting time to create value as new opportunities present themselves." In the meantime, Brough sees growth ahead for the Pinnacle Perks program as patients seek guidance and empowerment through the existing complex healthcare system, and employers look to save money and add value by using high-quality, costeffective providers. Given the history of Pinnacle Health and the success it has achieved over the years, it is a safe bet that Brough will have the company poised for additional success as the healthcare environment continues to change in coming years. I The CEO Edition I MD NEWS Greater Boston |7

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