Beacon Health Partners is a New York-based independent practice association (IPA), recently welcomed by the Centers for Medicare & Medicaid Services as one of its 89 new accountable care organizations (ACO) participating in the Medicare Shared Savings Program. Two of Beacon's leading executives, President and CEO Simon Prince, M.D., and Executive Director Jonathan Goldstein, MBA, spoke with FiercePracticeManagement about their experience forming an IPA/ACO and how this model fits with their outlook on the evolving picture of healthcare, following the Supreme Court's upholding of the Affordable Care Act.
FiercePracticeManagement: There's been some not-so-good news about the future of private practices and physicians' bleak outlook on health reform. How has Beacon accepted and adapted to changes?
Goldstein: We look at [reform] as an opportunity as opposed to something that's bad for practices.
I think the doctors see room for improvement in the way we deliver healthcare, and if we can get our heads around that and if we can deliver value versus volume, the docs might see a difference in what's happening, which is Medicare reimbursement decreasing or the constant threat of decrease.
Now there's an opportunity through the bonuses for doctors to get paid for some of the care-coordination services they should be providing but have had a limited financial incentive for performing.
Prince: In 2010, when we started [the IPA], I was president of the medical staff of a large tertiary hospital. A lot of my colleagues at the time were becoming employees of hospital and health systems, and amid the consolidation, there was concern over how private practices were going to make out in all this.
So we came together--right after the Affordable Care Act came out, with the desire to become an ACO--not really understanding what it meant at the time but awaiting the regs.
Obviously, we didn't like the first version of the regs, but it was a way to come together as a private physician network and take advantage of economies of scale and other changes with health reform as opposed to putting one's head in the sand and hoping and wishing it away. Our attitude was to embrace the change and prepare and take advantage.
FPM: How did the process of applying for Medicare's Shared Savings Program build on the work you'd done in forming an IPA?
Prince: We wanted to transform from a messenger model to a clinically integrated IPA.
A lot of the infrastructure that we were planning to put in place was around care coordination, disease management and other clinical initiatives that we're going to need from an ACO perspective. And this really galvanized us and focused us in a direction to execute on our ultimate vision, which is a thriving independent practice association.
We were on the path, and a lot of the things we were already doing made it easy for us to move forward and apply for the Medicare Shared Savings Program for July.
FPM: What are some of the lessons you've learned?
Goldstein: Communication and transparency with physicians is critical. An organization can name whatever it wants physicians to do, such as be on an EMR and use it meaningfully. But if you don't put the support in place to do that, it's just somebody else telling a doctor to do one more thing.
For that reason, we provide resources around Meaningful Use training, understanding the requirements and even helping them with their vendors and vendor selection to an extent.
Prince: Private practices are having trouble, and that's why they are joining hospitals and health systems, and we see ourselves as the alternative to that.
We are able to help the docs and the practices in some of the areas of economies of scale, group purchasing, IT support [and] education. That's of great importance as the private practices aim to remain independent and not become employed physicians.
FPM: How important is physician engagement to the success of your organization and its transition into becoming an ACO?
Prince: We're governed by docs; we're built by docs, we're all about physicians. That's the beauty and the challenge. We have a great core group of doctors--they're smart, autonomous people--but that's also part of the challenge.
This model gives us as much independence and autonomy as possible while coming together as a coordinated network, but one of our big initiatives is to educate and keep educating and keep everybody moving ahead together on the same page.
FPM: Under this structure, what is the daily life of a physician on the spectrum from being in a truly independent practice to becoming employed by a hospital or health system?
Goldstein: It's going to be somewhere in the middle; I say that cautiously.
If you accept that we're going to be taking care of a population of patients--and you can't do it as a private practitioner by yourself--but we have this organization, this ACO, that's going to help you and your practice take care of your patients, there's certainly going to be more communication going back and forth between the organization and your practice than you'd have otherwise.
Although you might hear from us a little more, it's because we're giving you information on your patients that you might not otherwise have access to, such as identifying patients who may be in need of intervention or have been admitted to a hospital and need follow-up.______________________________
"We're governed by docs; we're built by docs, we're all about physicians. That's the beauty and the challenge."
--Simon Prince, President and CEO, Beacon Health Partners
FPM: What changes do you foresee in the relationships between practices and third-party payers?
Goldstein: We've seen a lot of private payer ACOs coming about.
I think the relationship is changing, but the difference will be that the doctors and the groups who can demonstrate the ability to manage these groups of patients will have more flexibility in how they take care of them.
Maybe at some point some of the preauthorization requirements and all of the administrative burden will either be diminished or go away completely when these groups become at risk for the spending.
If we can do that and physicians don't feel like they're fighting for every penny--they can deliver care the way they're supposed to--maybe we can start making that transition from volume to value and the insurance companies can let the docs be docs. The relationships could get better.
FPM: What are your goals for the future?
Goldstein: The Medicare Shared Savings Program is effective July 1 so we want to start delivering on the promises of participating in that initiative.
Now that we've made these changes to our infrastructure and physicians have begun developing their skill sets for taking better care of patients at lower cost, we'd like to turn some of this early success into ACO contracts with other private payers. The docs take care of all patients to the best of their ability regardless of what insurance they have, but everybody benefits when they make improvements for one payer, and we'd like to see other payers respond by keeping that in mind.
Editor's Note: This interview has been edited for length and clarity.