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Physicians at Akron's Summa Health Move Forward Boldly on an ACO

July 13, 2012
by Mark Hagland
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The key, says the new ACO’s chairman, is to be physician-driven

When the Department of Health and Human Services released a list of 89 new participating accountable care organizations (ACOs) under the Center for Medicare and Medicaid Services’ (CMS) Shared Savings Program on July 9, one of those listed was NewHealth Collaborative, created by leaders at or affiliated with the Akron, Oh.-based Summa Health System.

In the case of the NewHealth Collaborative, Rodney Ison, M.D., CEO of the 27-physician Community Health Care primary care group, has become chairman of NewHealth, and is leading the charge to build this ACO in northeastern Ohio. Himself a family physician who has been in practice for 26 years, Dr. Ison notes that NewHealth Collaborative is very much physician-driven. About 450 physicians, half of them employed directly by Summa Health System or by medical groups affiliated with Summa, are involved so far.

Dr. Ison spoke recently with HCI Editor-in-Chief Mark Hagland regarding the formation of the ACO and his perspectives on the Shared Savings Program. Below are excerpts from that interview.

What was the core strategic idea behind your and your colleagues' forming this accountable care organization?

First of all, we all recognized that the healthcare system as it’s been developing, is not sustainable. And we had a health system [Summa] that was willing to align with us and not just own us, and willing to change the way we deliver care. And when you look at a health system that makes money from admissions being willing to change its admissions patterns to work with us to change care, that’s a pretty progressive system.

Rodney Ison, M.D.

Did Summa approach the physicians?

It basically was an extension of previous activity; but Summa was probably the primary driver. But we were  already collaborating on some clinical integration and computerization in our community.

When did you begin the process?

We officially started business in January 2011 with our first patient. Our first patient group was SummaCare’s Medicare Advantage members, patients receiving care who agreed to be a part of the ACO. There are 12,000 patients who agreed to be in the ACO model, perhaps nearly half of those patients in that overall program. And then in January 2012, we added the SummaCare employees, which brought 7,000 more people into the program.

What is your ultimate goal, in terms of numbers?

Well, our goal is to take care of the whole community. But with Medicare Advantage, we’ll probably be reaching about 40,000 patients. And if we can create the right model and meet the community’s needs, why wouldn’t we extend this to the whole community?

Tell us about the information technology foundations you and your colleagues have been putting into place?

We have multiple systems. And eClinicalWorks became a system that we’ve encouraged physicians to use. So for the ACO, there are several other things in process: one is a health information exchange, an internal one, which hopefully we can expand outside the system as well. But the first step is building the foundation internally. And Greg Kall, our [Summa] CIO, is overseeing that. We’re currently also working on call center development, which we’ll bring live in October or November.

Do you have a data warehouse yet?

That’s part of what we’re really working on right now.

What was the initial physician response to the initiative?

Like anything, it was all over the place. But most of the physicians were very excited, excited at the idea that we could improve care, could communicate among ourselves in a better way. In the past, everyone’s done their own thing in their own way. But this has been physician-led; the board has a physician majority. So this has very much been a physician-driven model, and the physicians are very excited. Of course, there’s always some skepticism; but the physicians have been very involved and have been working hard on this. And I’m very proud of them—the docs I get to work with, they’ve really done a wonderful job of embracing it and getting into it.

As I wrote in a blog earlier this week, it was surprising for some self-appointed industry experts how some of these ACOs are being developed in smaller and in less managed care-dominant markets. Some had predicted that they would only emerge in markets with completely dominant single integrated health systems.

I told people, our first job was to prove the experts wrong! [laughs] But to do this, you have to do this because of your mission, to take care of your patients. And you’re only going to succeed at this if you’re mission-driven; there’s not enough money in this model to do it purely for financial reasons. It has to be because this is your love.

So you’re pretty optimistic?

I think as a team, that anything can be accomplished.

What learnings have you and your colleagues had so far around IT and IT integration?

The first thing, more important than IT, is physician buy-in. The second-most-important thing you need is IT. And I have to tell you, every day, I see we need more. And we’re working on quality measurements. But the important thing is to be able to pull up data in real time, for example, if I find a patient needs to have their hemoglobin a1c taken care of. And IT is the reason we can do this. Fortunately, Greg Kall, our CIO, has a passion for us and for this initiative.