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. Late last month, HCI Editor-in-Chief Mark Hagland interviewed Rodney Ison, M.D., chairman of NewHealth Collaborative, regarding the core strategic opportunities and challenges involved in moving forward with this ACO initiative.
More recently, Hagland interviewed Charles Vignos, who is president of the Summa Health Network, the physician-hospital organization (PHO) and vice president of managed care at Summa Health System, and who is now also COO of NewHealth Collaborative, regarding his perspectives on this important initiative. Vignos has been with Summa Health System for about eleven years, and has a healthcare finance and accounting background. Below are excerpts from that interview.
What have been the biggest strategic and operational challenges in laying the foundation for the ACO?
One has been reaching out to the independent community physicians, and providing them with the appropriate education and understanding of what this model is designed to do. And then dovetailed to that has been the fact of rolling out initiatives within their clinical practices within the ambulatory setting that implement the changes in the clinical delivery of care that we’re looking to implement. And quite honestly, the last has been the trust factor. Historically, hospitals and physicians have worked in their own silos, trying to reach their own objectives. So a key element has been achieving transparency, in terms of objectives, in terms of clinical outcomes and everything we’re trying to accomplish. You’re trying to create that alignment between the hospital, the physicians, and the payer, which in this case is CMS, on behalf of the patient.
How hard has it been to explain these broad changes in healthcare payment to the physicians?
We’ve been working with physicians for years now; we started this journey in 2005, and it really started with an IT platform back in 2005. The physician leaders have been very much engaged. What has been challenging has been to communicate it down to their peers or partners, or employees, depending on what kind of model they have on their medical group staff, and to implement those workflow changes.
That’s the challenge, getting it down to that implementation stage. At a high level, they all buy into the “Triple Aim” from IHI [the Cambridge, Mass.-based Institute for Healthcare Improvement’s initiative to improve the health of populations, reduce the per capita cost of healthcare, and improve the patient experience]. So it’s, how do you improve the care quality, while at the same time improving patient satisfaction, and also reduce costs? So they buy into the concept, but the challenge is how that translates into what they do every day. So the issues need to be articulated to each of the audiences involved.
What was the initial IT component?
In 2005, we started a selection process for the physicians in our community to move forward on electronic health record (EHR) systems. Now, in terms of staff, we have about 25 employees under Summa Health Network, and we’ll probably have close to 25 employees under the collaborative. We’ve got about 450 physicians in the ACO—and 275 of those are employed, and 175 are independent physicians participating in this.
The EHR selection process was through the PHO, originally?
Yes. And the PHO was on a journey to develop a clinical integration model for the physicians in the community, and a key element of that was moving the physicians onto an electronic medical record system, and we’re continuing with that process. And dovetailed with that, we began to extract data from their EHRs, and we’ve been using MDDataCore as our vendor.
When did you begin to extract data?
About 2009. We do have a data warehouse. It’s a web-based product that gives them access to their clinical care gaps around chronic management, things like diabetes, hypertension and cardiovascular disease; it documents care gaps around mammographies, colonoscopies, and other wellness screening issues, via a dashboard. It’s an after-the-fact, retrospective review of how they’re managing their populations.
Are you hoping to make it more real-time?
That’s what Greg Kall [Summa’s CIO] has been working on, developing clinical data at the point of care. The data we’re getting is a weekly extract. He’s developing a real-time, HIE [health information exchange]-based process. He’s in a review process as we speak. So he’s looking at what vendors can deliver on that kind of model. The data we get is mainly being populated by physicians’ EHR systems, and we’re getting some hospital lab and diagnostic data, but he’s going to be able to make it real-time for all providers, and add a number of other additional data points as well.
How much of a challenge will it be to create a closed loop of information for the physicians, and how far along are you?
There are three components to that aspect of the work. First, there’s real-time information at the point of care. It involves a disease registry that can identify gaps in care among a population a physician is managing. And the third is population health analysis. The first part, Greg Kall is building, and the goal is to have a vendor selected this year and begin the implementation process in 2013; and it’s like anything else, in that you evolve forward, working with the different types and groups of physicians. But over the next couple of years, we should have that, and it should be pretty robust, to the point where all the community physicians working with us have that information. The disease registry is in place today.
The second component involves the clinical measures for the physicians—the 33 clinical measures that CMS [the federal Centers for Medicare and Medicare Services] says we need to be able to report on and improve—and we’ll be paid based on those. And we’ll be using the MDDataCore product to help us with that process. The third element is the population health analysis. And right now, we’re utilizing claims data to help us do this until the HIE can go live. So we’ve got a health plan, SummaCare, that we’re working with, and we’re working with Premier to help us find a vendor that can help us do the analysis as well. So today, when we get the file from CMS on the claims data, we’re going to be able to populate a database, and that will generate where we’re at with our current population.
When you look at the challenges ahead, do you feel pretty confident that you will be successful?
Absolutely. What the model looks like will continue to evolve, but absolutely we’ll be successful. The hospitals are very much engaged and want to see this be a success. The community and employed physicians very much want to see this be successful. The payers very much want this to be successful. Now, what this ultimately will look like, time will tell, but all three communities are engaged, and we know that these kinds of changes need to be made in healthcare. The question is, how quickly can you implement an HIE? How quickly can you implement some of these changes to physician practice? How quickly can you implement the patient-centered medical home model? So it’s just a matter of how quickly we can move forward on this new model. CMS has now given us a new payment model to allow this to happen. And SummaCare is working with us on the Medicare Advantage population.
Do you believe that the ACO model can succeed in a variety of markets and among a variety of different types of organizations?
Yes, I do believe there are a number of types of models that can succeed. The challenge is moving clinical care practice more towards this value-based model. If you’re moving only 5 percent of your population into a value-based model, it’s hard to justify the investment in infrastructure; but if you’re moving 90 percent of your population into a value-based model, it’s not hard to justify the investment at all.