Do you need a partner?
Commercial ACOs are being formed by physician practices, hospital collaborations, and health plans. Some providers and payers are in multiple ACOs. Your organization's decision should take into account the goals of the ACO as well as your technology and human resources capabilities.
Crystal Run Healthcare is a single-participant ACO, which means the physician group is clinically and financially integrated. Teitelbaum says the advantage of the single-participant ACO, which does not include a hospital, is that Crystal Run's physicians are free from the constraints of partnering with a single hospital. The physicians are free to shop around for facilities that offer the best care at a cost-effective price. "We don't have to worry about supporting one particular hospital."
Teitelbaum says most physicians don't have the scale, capital, infrastructure, or management in place to take this approach. Teitelbaum points out that Crystal Run already has in place a sophisticated IT structure as well as care and utilization management and the quality assurance teams that characterize ACOs. It also has database analysts who work with the business intelligence team to manage care and costs. In other words, the group isn't starting from square one.
Teitelbaum leaves open the possibility that, depending on its needs, the physician group may decide to partner with another organization as an ACO or just on a contract-for-services basis. "Just because an entity doesn't want to be at risk for costs, quality, and outcomes doesn't mean we can't work with them. But they won't be inside the ACO."
Mountain States Health Alliance, meanwhile, a 13-hospital system based in Johnson City, Tenn., opted for a more extensive structure for its ACO: Mountain States is the umbrella company that includes Mountain States Medical Group and Integrated Solutions Health Network. ISHN is the parent company of Anew Care Collaborative, the ACO, and CrestPoint Health, the third-party administrator that will contract with Anew Care as its payer.
As part of the ACO, Mountain States is partnering with four other physician groups that aren't part of MSHA. If you decide you need a partner, Wheeler says the most important consideration is a shared vision that drives outcomes. It was that shared vision that helped Allina and HealthPartners, competitors in the Twin Cities market, develop their collaboration in the Northwest Metro Alliance.
Wheeler adds that in considering a partner, you "can't underestimate the ability to marry claims information with really good clinical data" to develop a full picture of care. In the alliance, HealthPartners is able to provide Allina with data for its 27,000 patients. The ability to track those patients improves care by reducing the variability of practice patterns. "We know what is going on with them. We know when they fill their prescriptions, and we know when they are admitted to a hospital that's not in our system. When a patient arrives at our hospital or clinic we already have that information in our medical records so we don't duplicate tests. That's information that Allina on its own couldn't know."