As the accountable care organization (ACO) phenomenon evolves forward, new, innovative organizations and arrangements are emerging every day now. One organization that defies easy categorization is the Southfield, Michigan-based Prime Accountable Care organization. As the organization’s website describes it, “Prime Accountable Care, LLC is a physician-owned company with the sole purpose of operating as an accountable care organization (ACO). Our corporate office is located in Southfield, Michigan and we serve communities all across metro Detroit including Downriver, Dearborn, and Southfield. We also cover a large portion of Mid-Michigan, including: Flint, Saginaw, the Bay Region, and stretches into parts the Thumb and Northern Michigan. Prime Accountable Care, LLC was established on the same principle as an ACO, to improve health care delivery through higher quality of care and lower cost.” The organization’s website goes on to note that “Prime Accountable Care, LLC is unique in the sense that we are a single Tax Identification ACO with a focus on primary care providers. There is great synergy between the Medicare Shared Savings Program and our objective, which is placing the primary care provider at the hub of delivering care to the patient.”
Recently, three Prime Accountable Care senior executives—Mazhar Jaffry, its COO; Abbas Kermani, its CFO; and Diane Blackburn, executive director of its ACO—spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding their organization’s unusual journey forward in ACO development, and what they and their colleagues have been learning so far. Below are excerpts from that interview.
Tell me a bit about the origins of your organization, and your core organizational strategy?
Mazhar Jaffry: There are three types of ACOs in the United States. The first program was the Pioneer ACO Program—32 started in 2011-2012; only eight were in existence in 2016, when the Pioneer program ended. The others went out of business or converted to the MSSP [Medicare Shared Savings Program] program. That’s evolved and has three tracks. Track 1-Plus starts in January 2018, so there will be four. And starting January 1, 2016, they started the Next-Generation ACO Program.
Currently, 560 Medicare ACOs are functional; nearly 480 are MSSP ACOs. More than 60 percent are owned by hospitals; the remaining 30-plus percent are owned by private bodies—one group is existing IPAs or physician organizations already in existence. 80-85 percent of the 40 percent. And the remaining groups were formed and structured just to create an ACO. And Prime ACO falls into that category. It emerged by itself. The organization began to form in March or April 2015, and the approval process took 7-8 months. By January 1, 2016, CMS announced that we were part of it. Prime-aco.com website. There’s a tab for public reporting, which the announcement.
To form the group, the task for any ACO is to show they have 5,000 lives. So we gathered together more than 100 primary care doctors, and seven or eight specialists. The first day, we had 8,5000 lives, and 11,500 assignable beneficiaries in 2016. We’re now at 11,000-plus. And we have more independent primary care physicians. And those are mostly internal medicine and geriatrics, with a few family physicians. No pediatrics or OB/gyn, because Medicare doesn’t cover those. And 70 percent are in internal medicine. So we’ve got 150 providers managing 11,000 patients, in the ACO. And we have around 19,500 assignable beneficiaries, who will be added into the ACO here in Michigan. We’re also differently organized from many ACOs—we cover the metro Detroit area; then the second area is the Flint area; and the third area, comprised of two different parts, Saginaw, and the thumb of Michigan, with smaller towns, where there are three or four doctors here and there. And we’re doing a pilot project with Caro Community Hospital, in the town of Caro.
This is entirely physician-led, then?
Jaffry: Yes. There are 15 fully functional ACOs in Michigan, and nine are owned by the hospitals. The others are owned by physician organizations or physicians. In our case, we structured the ACO first. That’s why our focus is purely on the ACO. And in the future, we will go for participation in Medicaid and in Medicare Advantage plans.
Tell me a bit about the processes you’ve pursued around analytics-driven population health risk management, and around leveraging analytics to assess financial risk issues?
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