Fierce Q&A: CEO of Mount Sinai ACO stresses local coordinated care

The accountable care organization (ACO) movement still is going strong, as the Centers for Medicare & Medicaid Services yesterday announced 89 new ACOs to the Medicare Shared Saving Program. That brings the number of providers participating in Medicare Shared Savings initiatives up to 154.

Mount Sinai Care in New York City--part of Mount Sinai Medical Center--is among these newest additions to the accountable care program. FierceHealthcare caught up with Mark Callahan (pictured), M.D., CEO of Mount Sinai Care and chief medical officer and associate dean for excellence in clinical care at the school of medicine, to talk about the new program, why the organization signed up for the Medicare Shared Savings Program and what the future holds for the accountable care delivery model.

FierceHealthcare: What was behind the Mount Sinai's decision to participate as a Medicare Shared Savings Program ACO?

Mark Callahan: We see that the payment landscape is going to evolve rapidly over the next couple years and view the Shared Savings plan as an entry point to start getting some of the skill sets around population management and cost-effective medicine that are going to be critical in the future.

FH: So far, what has been the biggest challenge to implementing the ACO model?

MC: It's brand new for us here because we just got accepted for the July 1 start date, but we have been doing a lot of work in the meantime. There are a lot of challenges around care patterns in New York City, in general--around data access and sharing--and there are difficulties around trying to implement standardized care guidelines across our group of providers.

Those are things we think we can solve, but they are real issues, of course.

FH: What are the goals of Mount Sinai's ACO? What kind of outcomes do you expect?

MC: We want to really provide high-quality care to our Medicare beneficiaries that is also cost-effective care. To achieve that, we view our goals as reducing unnecessary readmissions by managing chronic diseases better. When we do have an acute care episode, we want to make sure that we do it right and do it quickly so that we have as few complications and readmissions as possible. By doing these things, we'll be able to also hold down the cost of care.

FH: What other organizations are involved in Mount Sinai Care and how are they aligned?

MC: The main providers are Mount Sinai physicians and Mount Sinai Hospital. So all the physicians are members of the full-time staff here or practices that Mount Sinai owns through the School of Medicine. Then we're using Mount Sinai Hospital Manhattan and Mount Sinai Hospital Queens. That said, we also have practices that are owned by Mount Sinai out in places as far as Long Island, Queens and up into southern Westchester.  

We're also going to work very closely with partners like Visiting Nurse Service, who has been a long-time clinical partner here at Mount Sinai and is going to be very important to our success in managing patients who need some kind of after-care or long-term care program.

FH: How did Mount Sinai providers react to the move towards accountable are?

MC: There is both skepticism and optimism at the same time. Physicians saw a move toward these types of programs in the 90s that ended up not being successful. So there's a lot of skepticism, especially among physicians who went through that whole era.

At the same time, I think a lot of physicians feel like there is a lot of room for improvement in the healthcare system. One thing that accountable care does, it tries to really work closely with physicians to do the right thing for their patients, and ultimately that's what doctors want to do.

FH: How did you get the physicians on board?

MC: A lot of meetings explaining what our goals are and trying to show how we are aligning the incentives for physicians to do the right things for their patients.

FH: What have you learned from other ACOs already in operation or from previous coordinated care efforts?

MC: We learned that care coordination needs to be very local. In the past, insurance companies tried to provide a lot of the care coordination through, let's say, nurse phone banks that may be in another state and that are very distantly related to the practice. That has not been shown to be very successful.

We believe the care coordination needs to be local in the practice, where the care coordinators know the doctors, know the staff and know the patients. We're hoping we get more success with a model that uses that.

We've also seen that Medicare has had some difficulty getting data to the Pioneer ACOs. We're hoping Medicare is going to be able to solve those problems fairly quickly because that makes it very difficult if we don't have access to information about what's going on with patients.

FH: What are Mount Sinai's plans for partnering with other organizations?

MC: We are in discussions with some of the insurance companies in the metro region because we think if we're successful with the Medicare program that this will have applications to other populations, as well.

As far as other provider organizations, I do see this evolving over time. But at this point, it's very preliminary to say what those discussions would be.

FH: How do you see the accountable care model evolving?

MC: It's going to evolve significantly in the next three to five years. It'll be both more prominent and involve other payers besides Medicare--Medicaid, as well as private insurers.

The Shared Savings model may not be what we're doing in three or four years. We may be doing some other kind of payment model, and whether that's a risk-sharing model or capitation of some sort, I'm not sure. But our internal discussions here at Mount Sinai, we feel that this is not where we will be in three to five years; we will be in a very different model.

What we're trying to do is be a very flexible organization to be able to adapt to those types of changes as they come, and to get the skill sets around population management and cost-effectiveness in our care patterns that will translate well into whatever that new payment model may be.

FH: Any words of advice for other hospitals and health systems thinking of building an ACO?

MC: You've got to get the doctors on board; that's critical step number one. And then you have to have a robust IT platform that is very integrated to be able to even try and do this. Because if you don't have an integrated IT platform, getting access to the kind of information you need to manage that population is very difficult to do.

Editor's Note: This interview has been edited for length and clarity.

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