Electronic Health Records

Adoption & Implementation News

How is accountable care changing provider collaboration?

By Kyle Murphy, PhD

- Compared to other accountable care organizations (ACOs), Amarillo Legacy Medical ACO in the Texas Panhandle is relatively unique. The participant in the Medicare Shared Savings Program comprises a handful of independent medical groups and not one hospital partner.

Although competitors, these medical groups have come together in order to qualify for the program but what has kept them going has been the ability to share information and best practices for the good of their patient populations.

William C. Biggs, MD, FACE, serves as the CEO of the ACO and Medical Director of Amarillo Medical Specialists. As he tells EHRIntelligence.com in the following interview, the presence of accountable care and adoption of ACO models have created an environment wherein collaboration in the service of quality is rewarded, none of which is possible without the ability to access and exchange actionable health data.

How did Amarillo Legacy Medical ACO come into being?

We basically started out with a concept in 2012 with just my group alone. We thought we would apply as an ACO and felt that we could manage patients in a way that would improve their care and reduce cost. However, there is a minimum requirement of 5,000 primary care patients attributed to you for the Medicare Shared Savings Program, so we then reached out to a couple of the family physician practices in Amarillo to see if they would partner with us in the ACO. We expected that maybe one of them would, but both of them did. That got us up to about 12,000 patients between all those groups. We started January 1, 2013.

READ MORE: How EHRs Help Make Successful Accountable Care Organizations

What health information technology is enabling the ACO to achieve its goals?

It took us a few months basically to look at how we were going to accomplish the IT part of it. In order to do a good job, this is a pretty IT-intensive endeavor and IT makes it possible really. We had quite a bit of familiarity with eClinicalWorks. We did look at a few other systems. We talked to Optum. We looked at Phytel. They didn’t have the same kind of complete solution that eClinicalWorks had, plus we had a pretty good working relationship with eClinicalWorks in the past with our EHR, so we chose them. We had the care management module deployed by May, had the health information exchange and our first patients live on that by June.

How has the proper adoption of health IT helped the work of the ACO?

One of the huge strengths of the Medicare Shared Savings Program is that we get all the claims data on our patients. We are able to get all the Part A, Part B, and Part D claims that come in on our patients and with the analytics part of the eClinicalWorks suite of products we can see what’s happening with our patients, which skilled nursing facilities or home health services are they using, which hospitals are our patients being routed to, whom are our providers referring to. We realized that we were over-budget compared to other ACOs in terms of home health. We asked eClinicalWorks to see if they could then scan through the data to determine how many ER visits and hospital admissions occurred after a home health agency had touched one of our patients and built that as surrogate for quality and cost.

How did that data and analysis then impact arrangements with other providers?

READ MORE: Two More Pioneer ACOs Opt Out of Value-Based Program

We came up with a value index on home health agencies. We then used that data to go to the three top-performing home health agencies and tell them that we wanted to work with them more collaboratively and send all of our patients to you because you seem to be doing a good job for our patients. Then we went out to our hospitals and told them for our ACO patients who are admitted that we wanted them to give those patients a choice of these three home health agencies that appear to be doing the best job. That steers our patients to the agencies that we think are of the highest quality and that should reduce our costs. It is still too early to assess how that has reduced our costs. We took the same approach and applied that also to skilled nursing facilities that our patients may be going to after hospital admission as far as scoring them and reaching out to them.

Would this have been possible without accountable care models?

Prior to an ACO environment, I don’t think any of our doctors thought that was possible or they may not have cared because they were not in any way responsible for the costs, so they might have thought, “Well, good for them if they are able to charge double compared to the other place.”

Obviously the agencies that we have chosen to work with are thrilled that they came out doing well and feel like their efforts have been rewarded as far as having a high-quality organization. The companies that didn’t get chosen have also come to me and asked why they weren’t picked to work with us and what they can do. These are conversations that they have never, ever had with a referring doctor — that we’re choosing you on the basis of quality and that we’re developing our own quality reports and sharing them with our doctors. That is completely alien to them. Previously, they got their business by bringing in pizza for the doctors for lunch. They have to compete on something else. That is going to raise the bar for all of the agencies, not just the ones that we work with.

Are the founding medical groups still competitors? How does that play out in an ACO environment?

READ MORE: Readying EHR Technology for Population Health Management

Absolutely, we’re competitors. We still compete in some ways. Even competitive doctors still want to collaborate. We have always wanted to work together. There have been some tensions, but we all understand that in the future this is how medicine is going to be. We’re going to have to get to back to working as a healthcare team. They are going to share the same consultants. They can share from the knowledge base on best practices. They benefit from getting reports back about how they measure up on various quality aspects and compare with their competition.

Doctors are intensely competitive. If they are not one of the top performers, it really bugs them. That’s healthy. That is something that they strive to do better. A doctor could have graduated from medical school in 1972 and once they are out of their residency no one has necessarily assessed them or given them any feedback on how their doing from a quality perspective. This is closer to real-time. They get reports that are relevant and accurate, and they benefit from that. It confirms that they are doing a good job and identifying what they need to improve.

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