Lessons from a rural, physician-led ACO [Interview]

Medicare accountable care organizations (ACOs) generated $411 million in total savings in 2014, but only a minority of the Pioneer and Medicare Shared Savings Program (MSSP) ACOs qualified for bonuses in the second year of the program. 

One of the few success stories is the Cumberland Center for Healthcare Innovation (CCHI), an MSSP ACO comprised of 40 primary care doctors who own and manage their own practices across 15 counties in rural Tennessee. CCHI generated savings of $7 million for CMS, resulting in a $3 million reward to the ACO. These figures represent substantial amounts considering how many other ACOs are still trying to crack the code.

The doctors attribute their success to a few factors, according to Brent Staton, M.D., pictured, owner of Staton Southern Medical in Gordonsville, Tennessee, and CEO of CCHI, who shared his insights in an exclusive interview with FiercePracticeManagement.

FiercePracticeManagement: Why do you believe so many practices have struggled to achieve shared savings?

Brent Staton: It's a learning curve. When Medicare started its ACO program, there was not a specific model per se to use. There was not a playbook. From that aspect, I think it is a struggle; but we've been able to turn that struggle into an advantage in our ACO, and we've been successful in reaching shared savings the past fiscal year.

FPM: Some might also consider operating in a rural ACO to be more difficult than practicing in more urban areas. Has that been the case for CCHI?

BS: As rural primary care doctors, you have to understand our perception of medicine. We love our communities. We love the people who are in our communities and we've chosen to live in these communities because of that connection that we have with the people in these small towns. When I go down to the local diner, I'm sitting there with my patients. So it was kind of a no brainer for us to move straight into an ACO to provide higher quality care for our patients. We want to make sure we provide that care because it doesn't just affect an individual patient; it affects our community as a whole. The healthier the patients we have, the healthier communities we have, and we're part of those communities.

FPM: What are some examples of how your ACO has improved care?

BS: We have in our communities approximately 14 hospitals that we impact or touch. We've had an effect in reducing readmission rates in those hospitals, which benefits our community hospitals. We may not be officially partnered with them, but we consider them partners in our community. We affect these results by making sure all of our patients get their wellness visits, we focus on quality measures, we manage transition of care and we focus diligently on chronic care and disease management. That allows for patient engagement and also, as an ACO, it allows for physician engagement.

FPM: Since there is no guidebook to running a successful ACO, as you mentioned, where do you go for advice?

BS: It's interesting being a rural primary care ACO. By nature, we were somewhat isolated as far as being in our individual communities the sole medical providers or one of a few providers in those communities, so we've done a lot of learning from within. But of course, I've reached out to several successful ACOs and several have reached out to us just to communicate about what we're doing.

FPM: What's next for CCHI?

BS: We're expanding our current footprint. We've a little more than doubled in size our new contracts for 2016. In addition to Medicare, we contract with four other insurance companies in ACO models. That's quite a bit of expansion for a small ACO to tackle, but I think it's going to be worth if for the future of our practices.

FPM: What would you say to practices that think ACOs aren't yet worth the effort?

BS: Join an ACO. Become engaged in an ACO so you can be a part of driving change in healthcare in your communities. The future of healthcare is going to be risk-based. If you're not in an ACO, you're going to be passed by. - Deb (@PracticeMgt)

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