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Achieving success in a physician-led ACO

Insight Article - December 14, 2021

Population Health

Coding & Documentation

Value-Based Operations

Defining what makes a successful accountable care organization (ACO) can be looked at in a few different ways.

At its most basic, it’s “trying to get physicians who are not on the same tax ID number to be able to move in the same direction,” according to Lawrence Preston, MBA, FHFMA, chief executive officer and cofounder, Silver State ACO, who joined Rhonda Hamilton, LPN, chief operating officer, Silver State ACO, in talking about Silver State’s journey at the 2021 Medical Practice Excellence: Leaders Conference.

It’s much more complex than that, of course: The challenge of this approach is successfully using analytics to influence physician behaviors and staff workflows to better coordinate care, control costs and effectively manage specific quality improvement plans.

“The most difficult thing is the coordination of care,” Preston said, in starting out as an ACO, since there’s generally no good sense of what beneficiary spending is. That information is even harder to get in areas where the beneficiaries are “snowbirds” and travel throughout the year and get care across the country.

Background and results

Silver State ACO got started in the Medicare Shared Savings Program (MSSP) after applying in 2013 and starting in 2014 — opting to operate as a Track 3/Enhanced ACO in Nevada to equally share generated savings with the government — and serving an area with 45,000 attributed beneficiaries across more than 730 participating providers with 55 independent tax ID numbers and more than 20 unique EHR and practice management (PM) systems among them.

In some ways, Silver State is “very disjointed” because of that variety and because some of the participating providers traditionally competed against one another. The ACO helps unify them under the same goal, Preston noted, by helping them utilize information they didn’t have before about those patients and the costs of care delivery.

Under the plurality model of patient attribution, providers with the most visits and E/M codes generally get patients attributed to them. In Silver State’s area, about half of a primary care physicians’ patients are attributed to the PCP, and the rest to specialists. “That’s a bell curve we would love to be able to flatten out,” Preston said, noting that the PCP’s role in care coordination would ideally lead to most of those patients being attributed to a PCP. “We would love to see a 75-25 [split].”

From 2015 to 2020, the ACO achieved shared savings six times and generated more than $162.8 million in savings to the Centers for Medicare & Medicaid Services (CMS), which was good enough to rank in the top 6% of ACOs in 2020, including ranking eighth out of the top 10 ACOs in the United States in earned savings and second overall for per beneficiary savings.

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