The physician group contracts with 4 hospitals in Orange and Sullivan counties, which are located about an hour northwest of New York City. It also contracts with an academic medical center in Westchester County as well as one in New York City.
Crystal Run has for years been working on two parts of the popular "triple aim" for healthcare: better care and better health. The physician group's 15 sites are linked by a single electronic medical record system, and it has invested in patient care managers for more than 10 years. That hasn't been a reimbursable expense under fee-for-service arrangements, but Hines expects that with the ACO the group will begin to reap the financial benefits of having an established care management model in place.
Hines says cost, the third leg of the triple aim, hasn't been addressed because "frankly we haven't had to until now." He explains that there hasn't been a lot of Medicare Advantage or risk-based contracting in the group's service area compared to other parts of the county, but that's beginning to change.
Crystal Run will participate in track one of the MSSP. There is the potential for reduced revenues and reduced bonuses if the group doesn't meet patient quality and outcome goals.
The preparation and approach Crystal Run Healthcare is taking in developing its ACO sets it apart from the findings of the 2012 HealthLeaders Media Accountable Care Organizations Survey.
According to our survey of healthcare leaders, many remain uncertain about the value of ACOs to their organization, many are operationally unprepared for ACOs, and financial risk remains a potential stumbling block for ACOs.