Focus on advanced primary care improves success of ACOs, study finds

A mature woman physician consulting with a patient in the doctor's office.
A focus on primary care can help spell success for accountable care organizations, according to a new study.(Getty/Ridofranz)

What do the most successful accountable care organizations (ACOs) have in common? A focus on primary care, according to a new study.

The report (PDF) released yesterday by the Patient-Centered Primary Care Collaborative (PCPCC) found that ACOs—which typically include a network of providers including specialists and hospitals who are accountable for a cohort of patients—achieved better results when they leverage advanced primary care models such as patient-centered medical homes (PCMH). 

The results included improved population health, lowered costs and enhanced patient experiences to a greater extent than those that did not focus on advanced primary care.

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“ACOs and advanced primary care models both strive to improve quality, reduce costs, and put the patient at the center of their care, but each model has evolved separately. Incorporating advanced primary care in an ACO environment can drive meaningful change,” said Ann Greiner, president and CEO of the collaborative.

This was the first time that the annual study by the collaborative tried to answer the question of how PCMHs or advanced primary care models impacted ACOs, said Yalda Jabbarpour, M.D., a family physician and medical director of the Robert Graham Center, who was one of the report authors.

In a panel discussion hosted by PCPCC to discuss the study, Ann Hwang, M.D., director of the Center for Consumer Engagement in Health Innovation, said the study results are not surprising. “Primary care is the main point of contact for most people,” she said. The health care system must be built around patients’ needs, with consumers wanting a champion to help them navigate that complex system, she said.

And doctors and hospitals have a big reason to get on board with value-based care, said Mai Pham, M.D., vice president of provider alignment solutions at Anthem. “We’re quite ready to leave some providers behind,” she said since it is clear not all providers are created equal and payers want to work with those who provide high value, high-quality care.

Pham also talked about what she called the elephant in the room—the Medicare physician fee schedule which she said is the foundation for the healthcare system but acts as a “red brick wall barrier” in fixing undervalued primary care.

Reasons for doctors to opt-in

For doctors, the dynamic of working in-network can be incredibly powerful, said Farzad Mostashari, M.D., co-founder and CEO of Aledade, a start-up that is partnering with primary care physicians to build and lead ACOs.

The report shows that ACOs and PCMHs are well aligned to take better care of patients, make physicians’ lives easier and save money, said Robert Mechanic, executive director of the Institute for Accountable Care. He said there are a number of reasons why doctors can benefit by participating in ACOs.

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Working in a larger network means more practice support, he said. It also allows practices to incorporate new services for patients, which can be difficult for smaller primary care practices to do. As an example, he cited one organization which was able to hire 50 community health workers who are able to help patients with needs ranging from medication reconciliation to transportation.

Doctors, particularly if they are part of a Medicare Shared Savings Program ACO have lower reporting burdens under MACRA. Participating in an ACO can also allow for innovative contracting. “I think it’s a great fit,” he said.