Forget MSSP, You've Already Started a Commercial ACO

Karen Minich-Pourshadi, for HealthLeaders Media , March 5, 2012

Shields says that, although the commercial ACO agreement raises the bar even higher for Advocate's performance, it's a natural next step for the system. In fact, they were able to get the program off the ground in just three months.

Could your organization move as fast? Shields says it's essential that providers looking to establish a commercial ACO build off of existing payer relationships, as his organization did. Advocate Physician Partners is a joint venture between Advocate Health care and the 3,900-plus physicians on the medical staffs of the Advocate hospitals. It has spent the last nine years working with its payer and unifying practitioners through a clinical integration program—an important precursor to an ACO model.

Advocate Physician Partners' integration program was actually funded by health insurance plans as well as the Advocate system. The goal was to unify both employed and independent physicians into a single comprehensive care management program.

The integration model established a common set of goals and measures across all insurance carriers while giving the physicians an infrastructure and support. In addition, the payers established a pay-for-performance incentive system. It was this clinical integration program that gave Advocate a solid foundation to launch a commercial ACO with BCBS of Illinois, says Shields.

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