As the accountable care revolution rolls forward, it is inevitable that some of the most innovative leaders of that revolution are senior executives of multispecialty medical groups. After all, it is physicians who work most closely and regularly with patients, particularly the high-risk, high-cost patients whose utilization is leading the bulk of expenditures in the current healthcare system nationwide.
One of the pioneering organizations in the accountable care organization (ACO) space is the 300-plus-physician, 17-location Crystal Run Health Care, in New York state. Founded 18 years ago, Crystal Run Health Care is based in Middletown, an hour northwest of New York City, in the Hudson Valley region. Its main service area encompasses the counties of Orange, Sullivan, and Rockland, as well as a part of Westchester County, and a small office in northern New Jersey. Two physicians on the Upper East Side of Manhattan are also Crystal Run doctors.
Crystal Run Health Care is a participant in the Medicare Shared Savings Program, and was one of the initial first-round MSSP organizations when it joined the program in April 2012.
Gregory Spencer, M.D., Crystal Run’s CMO and CMIO, was one of a number of healthcare leaders interviewed by HCI Editor-in-Chief Mark Hagland for the magazine’s July-August cover story. Below are excerpts from his interview with Hagland earlier this summer.
What made you and your colleagues decide to participate in the Medicare Shared Savings Program for ACOs?
We’ve been moving into a value-based direction for a long time. We’ve been Joint Commission-accredited as a private practice; we received an ambulatory certification; we were one of the first in the country to do so. I was the seventh doctor and second internist when I joined the practice in 1996; and we were growing very quickly, and felt that how the Joint Commission approaches safety was appropriate. In addition, we wanted to define ourselves from a marketing standpoint, and to demonstrate objective quality, so for a bunch of different reasons, we decided to become accredited.
Gregory Spencer, M.D.
And we early on became a patient-centered medical home. We’ve been on an electronic health record since 1999. So in sum, we’ve had a long tradition of data-driven care, and, seeing that pure fee-for-service reimbursement was not a long-term prospect, we made the decision to move in this direction [of becoming an MSSP ACO]. We were initially a finalist for Pioneer MSSP, but because of our size, they wanted bigger groups, and we felt we needed experience with claims data, and that [becoming a regular MSSP participant] was a way to do that relatively painlessly as much as you could say those words—to learn how to manage the population and learn what the data meant. And it’s been successful that way.
The setup of the program is such that you still get fee-for-service payment; and there’s a downside in that patients can go wherever they want, and it’s not a narrow network. But it’s very much worth it. And we have our application into the state of New York to create a health plan, too. We really felt that we should do something to try to cut out a middleman, to not have a shareholder entity take a large percentage of profits off the table. Instead, we’d prefer to be on the top line of that, and be able to share a bit of the savings; and we take care of patients over a long period of time, and we might as well involve the patient, and kind of do performance risk as well as insurance risk.
You’d be going directly to employers with your health plan product?
Yes, and consumers will be able to come directly to us as well. We’re going to be a narrow-network product. The majority of the care would be performed by us. And we’re going to be agnostic. I’m a doctor, I don’t look at patients.
If the state of New York approves it, when would you become a health plan?
January 2015. It would be Crystal Run Health Plan.
Everyone has shared that successful patient attribution is harder than it looks.
The attribution piece is huge, and really, every payer is slightly different, and it might seem simple, but it’s not. And what do you do with people who see a lot of urgent care but don’t really have a regular primary care physician? And by being attributed, you’re saying, well, you might get some sort of PMPM [per member per month] payment, and that’s good, but if you’re now responsible for the outcomes metrics for a patient and you don’t have a relationship with that patient and aren’t able to hit the quality gates, you’ve missed your opportunity for savings.” So, he says, it is vital to get attribution right, and to link successful attribution with successful engagement of all active patients in the ACO.
Are you using business intelligence tools in this work?
Yes, we have our own business intelligence department. We just hired two people, so I think we will have ten, but we’re eight, currently.
With regard to business intelligence, what have been the biggest challenges and learnings so far?
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