Value as a business differentiator: 6 execs on what makes their ACOs high-performing

In mid-September, CMS released 2019 results from its Medicare Shared Savings Program ACOs, with participants generating a record $1.2 billion in total net savings for the program.

Becker’s reached out to executives from ACOs that earned some of the most shared savings in 2019 to share what strategies and best practices they believe led to their positive results. 

Here’s insight from six executives:

1. William Mayer, MD, president and CEO of Affirmant Health Partners and the Federation ACO (Portage, Mich.). Our success can be attributed to our focus on changing specific provider behaviors using what we refer to as our “fire triangle” — three strategic elements we believe must be present to produce this change, just as fuel, heat and oxygen must be present simultaneously to ignite and sustain a fire. These three elements are data analytics to inform us on our performance, clinical transformation to improve performance, and shared savings to ensure our enterprise is sustainable. We deliver standardized, valid and reliable quality, utilization and cost measures at the level of the network, practice, physician and patient to physicians at the point of care and to administrators on demand. We provide a clinical transformation system to identify evidence-based best practices and interventions to promote their rapid adoption. We have also contracted with Medicare Advantage plans, in addition to our MSSP participation, to enable us to share in savings produced by physician behavior changes affecting all their Medicare patients. All these elements combine to produce a virtuous cycle of improvement in the value of care we deliver for our patients and our communities in advancing our vision of a healthy Michigan at an affordable cost.

2. Tim Gronniger, president and CEO of Caravan Health (Kansas City, Mo.). There are three keys to this success. First, our successful care transformation is based on proactive preventive care that keeps patients healthy and chronic conditions well-managed. With our proven methodology, nurses are in charge of population health service delivery. This allows everyone to work at the top of their license and gives physicians more time to lead care teams. Second, our collaborative ACO’s governance model gives each provider a voice in running the ACO. Our providers are aligned on objectives, methods and roles. Regularly scheduled leadership meetings and scorecards hold participants accountable to each other. Lastly, larger ACO size is necessary to allow good performance to shine through statistical noise. Small size can lead to wildly unpredictable results from year to year. In an ACO with more than 100,000 lives, every participant can be confident that ACO results are accurate and not swayed by statistical variation. The strong results of our largest ACO bear this out.

3. Gary Stuck, DO, chief medical officer of Advocate Aurora Health (Milwaukee and Downers Grove, Ill.). We have the advantage of being committed to value-based care for a long time. It’s incredibly important to have an engaged group of primary and specialist physicians and then have the right incentives for them to stay engaged and work together. You also need to invest in the infrastructure, people and technology needed to succeed. Specifically, we’ve made appropriate reductions in the use of post-acute services and have focused on a “home first” initiative aimed at discharging patients to the appropriate next care setting, ideally home if clinically appropriate. We’ve expanded predictive analytics and care management programs that identify patients at high-risk for hospitalization and readmission to facilitate interventions to reduce adverse and costly health events. And we’ve improved primary care and preventive health services to help people live well.

4. David Carmouche, MD, president of Ochsner Health Network (New Orleans). It’s clear to me that success starts with a clear and compelling vision, one that articulates healthcare value — better health and health outcomes at the lowest possible cost — as both a noble purpose and a compelling business differentiator. That clear vision then attracts leadership talent, secures needed resources and inspires and engages the provider organizations within ACOs. Transformed primary care, sophisticated population health services and adequate capabilities in data management and analytics are also key components for success in value-based care.

5. Laura Irvine, chief network strategy officer at Baylor Scott & White Health (Dallas). Our 2019 results demonstrate our continued commitment to making healthcare better and more affordable through provider-led care coordination and design. For the second year in a row, we have delivered significant savings for Medicare; in fact, after we began taking downside risk in July 2019, our work generated some of the highest savings in the nation. As the largest clinically integrated network in Texas, we are proud to have achieved not only the highest savings in the state, but also one of the highest quality scores.

6. Rupesh Dharia, MD, internist and founding member of PBACO (Palm Springs, Fla.). We’re pleased that our high-performing network of independent primary care and specialist physicians continues to show great results for Medicare patients and the Medicare program. Our independent physicians associate their high quality and efficient patient care with the preservation of their practices and their profession. They go the extra mile to keep their patients healthy and to manage their conditions because their job literally depends on it. Considering that our group has been among the top two ACOs in the nation in each of the last seven years, we hope that other independent physicians see our success, start their own ACOs, and lead quality and efficient care in their markets. 

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