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Massachusetts Mojo: What Bay State ACO Leaders Are Learning That Really Matters

July 14, 2014
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What’s happening these days in Massachusetts is absolutely something that healthcare leaders from across the U.S. need to be paying attention to, as Baystaters are helping to lay the foundations of the new healthcare

What’s happening these days in Massachusetts is absolutely something that healthcare leaders from across the U.S. need to be paying attention to—and even healthcare leaders outside the U.S., I’d argue. There, as in a growing number of other healthcare markets nationwide—one thinks immediately of the Minneapolis-St. Paul metro area, the Cincinnati metro area, certain other metro areas in the Northeast, and some of the larger markets in California and the Pacific Northwest—the foundations are being laid for the new healthcare, a healthcare system of improved care quality and patient safety, better cost containment, greater accountability and transparency, expanded payer-provider collaboration, and an increased focus on value-driven rather than volume-driven healthcare delivery and payment.

And Barbara Spivak, M.D., president of the Mount Auburn Cambridge Independent Practice Association (MACIPA) in the Boston area, is in a better position than practically anyone, to be able to articulate what’s going on in Massachusetts in terms of accountable care and value-based care delivery and payment. That’s because she and her colleagues have been pushing ahead very affirmatively to make accountable care happen, and work, as she told me this spring. Indeed, she was one of several healthcare executives whom I interviewed for our July-August cover story on accountable care organizations (ACOs), who were able to share with me the tremendously important learnings taking place these days in this exciting area of endeavor.

What I was particularly impressed by was  Dr. Spivak’s explanation of why MACIPA as an organization has gone the route of accepting risk-based contracting as the basis of all of their managed care contracting. “There were several reasons” for affirmatively pursuing risk-based work, she told me. “One was that we as an organization believe that managing the care of patients provides better care, and that in order to effectively manage the care, you need to get data from the health plans. Particularly in an environment like ours where there is a lot of fragmentation of care, even more in the senior population than in the younger population, it’s very important to get information on where they’re going,” she continued, adding, “And if you’re going to enhance their care, somebody has to pay for that. And the only way to get that is to enter into some sort of risk contract with a payer, in this case, Medicare. And you’re really only talking about the sick patients—the healthy patients you may run registries, but managing care is focused on the sick patients.”

Of course, the senior leaders of many patient care organizations, and particularly of many physician groups, are still resisting taking on considerable amounts of risk right now, as they tentatively begin laying the foundations for participation in the new healthcare. Yet the reality is that it is the pioneers like MACIPA—and of course, they are literally “Pioneers” as well at MACIPA, being a Medicare Shared Savings Program Pioneer ACO from the start—that will find themselves best situated to benefit from their early participation in accountable care work, and prepared to vault ahead of their competitors in their markets, based on strong leadership and a willingness to sail into uncharted waters.

And of course, as Dr. Spivak noted, far more intensive patient management is required in the Pioneer program, not surprisingly. What’s more, of course, the need for leading-edge information systems and informatics is intense and intensified in such settings as well. Like everyone else I interviewed for the July-August cover story, Dr. Spivak affirmed that initial steps involved in working to mesh claims and clinical data have been challenging, and that it takes a lot of brainpower and a lot of hard work to begin to reap the rewards from such efforts.

Yet the simple reality is this: what Dr. Spivak and her colleagues at MACIPA are doing, as well as what Heritage Medical Systems, Crystal Run Health Care, Steward Health Care System, Mission Point Health Partners, and others are doing (please see my cover story)—all of this work—is not only vital to the creation of the new healthcare, it is also inescapable. There is simply no “shortcut” to doing this foundational work, at least not right now. And those patient care organizations whose leaders decide to hang back and wait for everyone else to do all the innovation work will find that by the time there are templates for this kind of work, they will be hopelessly behind their peers who have been doing the groundbreaking work ahead of them, and their local-market options will be dramatically narrowed.

So it is to the leaders of physician groups like MACIPA in particular that I doff my hat, because they are moving forward in an area that is both tremendously fertile, and also involving the steepest vertical ascent—the area of physician practice. But keep watching this space: in the next few years, what organizations like MACIPA will have achieved will indeed be replicable nationwide, with great results.