Pioneer #ACO Repurposes Care Management for Accountable Care

As a top performer in Year 1 of the CMS Pioneer ACO program, the 2500-physician Monarch HealthCare is paving the way to accountable care with a foundation of patient- and provider-centered strategies that support Triple Aim goals.

Those goals – to improve quality, improve health outcomes and reduce cost, are detailed in Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care.

Colin LeClair, executive director of ACO for Monarch HealthCare, recounts how Monarch recast its Medicare Advantage (MA) care management program to target about 1,200 high-risk patients who have a similar constellation of issues.

“Monarch repurposed our Medicare Advantage (MA) care management program for the ACO,” LeClair said.

Monarch’s ACO care management team was designed to anticipate and prevent acute events and then to facilitate transitions of care for patients post-discharge, he said.

This interdisciplinary team is “comprised of a primary care physician who quarterbacks the team, and a care navigator, also known as a care coordinator, who performs most of the patient onboarding into the care management program and performs an initial triage of the patient’s needs,” LeClair explained.

The care manager is often a non-complex patient’s primary point of contact. The complex care manager is responsible for most of the complex cases, he said.

Then as needed, “we also deploy a behavioral health clinician, a community services coordinator, a clinic dietician and a palliative care nurse. The other resources may include a pharmacist or Pharm D to perform post-discharge medication reconciliation.”

Then, LeClair continued, “we have a team of medical directors, employed and contracted hospitalists, and employed and contracted skilled nursing facilitators (SNFs) to support us as well.”

The idea is that the team is tailored for the patient’s need at enrollment, and it can then be augmented as the patient’s health status changes, he observed.

This model scales best when you can target large patient populations with a fairly common list of conditions, which allows you to hire and assign clinicians with the appropriate expertise to each patient.

“For example, we can afford to hire and assign a registered nurse (RN) or a nurse practitioner (NP) who has experience in a dialysis clinic or a nephrologist office if we have enough renal disease patients to fill their case load,” LeClair said.

For more information or to order your copy of Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care today, please visit: http://store.hin.com/product.asp?itemid=4841

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Managed Care Information Center ‘Store’ New Web Address

Our health and managed care databases
store page has a new web address following
our migration to our new,improved web site
at healthresourcesonline.com.

The store is protected for security with “Secure Socket Layer” or SSL to keep your transactions secure.

Because there are so many links to our directory – databases and management resources up on the Web we think it is a good idea to give you the new location link:   https://www.healthresourcesonline.com/payer-provider-data.html

Free Slide Presentation Provides Details About the National Directory of Physician Organizations Database

A free slide presentation with details about the National Directory of Physician Organizations Database is available.

Interest in physician organizations has grown in recent years due to a number of factors and they have taken on new importance and energy.

The physician organization database includes details and contact information on independent practice associations (IPAs), physician hospital organizations (PHOs) large multi-specialty medical groups, primary care networks and practice management services organizations.

The database is researched and produced the Managed care Information Center (MCIC.)

To receive your free, no obligation copy of the National Directory of Physician Organizations Database slide presentation please click on this link now: National Directory of Physician Organizations Database Free Slide Presentation

Physician Organizations – IPAs – PHOs Can Improve Care Management For Smaller Practices, New Study Finds

On average, physician practices participating in independent practice associations (IPAs) and physician hospital organizations (PHOs) provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did, the results of a new study found.

The difference is dramatic – 10.45 percent versus 3.85 percent, found the researchers. And, half of these processes were provided only by IPAs or PHOs.

All the recent initiatives surrounding physician practice including pay-for-performance, public reporting, and accountable care organization programs places pressure on physicians to use health information technology and organized care management processes to improve the care they provide.

The problem is physician practices that are not large may lack the resources and size to implement such processes.

The researchers said they used data from a “unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which IPAs and PHOs might make it possible for these smaller practices to share resources to improve care.”

Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients, the study found.

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IPA-PHO Database – The National Directory of Physician Organizations profiles more than 1,300 physician organizations. Listings include: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, physician primary care networks, and management service organizations (MSOs) The National Directory of Physician Organizations

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These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations, said the researchers.

“The data presented suggest that IPAs and PHOs may be able to provide an additional, potentially viable organizational alternative during an era of major changes in how health care is delivered and paid for,” the study authors wrote.

The research team was led by Lawrence P. Casalino, MD. The study results appeared in the August Issue of Health Affairs.

Physician Organization Leadership Frustrated With Shrinking and Changing Payer Reimbursement, Increasing Administrative Work Load

“Reimbursement that does not even cover costs”

Shortages of primary care physicians: fewer primary care physicians in the face of more patients means those in practice will have to shoulder more responsibilities, is a key challenge cited by a vice president of a physician practice management company.

Along with that issue physicians “juggling increased administrative burdens with maintaining patient quality of care,” the VP observed.

The concerns of executives and administrators of physician organizations emerge from the results of the Continue reading

Physicians Need To Adapt and Develop A Vision For the Future, IPA-PHO Survey Finds

The resurgence of hospitals buying physician practices, the shortage of primary care physicians, contract and reimbursement models, market consolidation and the pressure to transform primary care practices are among the key issues the leadership of the nation’s physician organizations – PHOs and IPAs are keenly concerned about.

The issues emerged from the results of the IPA -PHO Physician Organization Leadership Survey 2012 by the Managed Care Information Center (MCIC.) Continue reading

A Glance Back: Boom Times For Growth of New IPAs Began to Slow Dramatically in 1999

Despite today’s somewhat ‘rosy’ outlook for physician organizations, the IPA equivalent of the Dot Com bust occurred in 2002 when only two new IPAs were formed, found Managed Care Information Center Research.

The peak year for IPA growth was 1994 when 174 new physician organizations formed, according to data for the National Directory of Physician Organizations Database. The year 1995 was close with 138 new IPAs formed, our analysts found.
Source: The National Directory of Physician Organizations Database. http://healthresourcesonline.healthrespubs.com/managed_care/23poe.htm