FH: Some healthcare execs are hesitant to sign up for the Medicare ACO, although they might be interested in the accountable care concept. For example, they might seek accreditation through National Committee for Quality Assurance but not apply to CMS. What was Atrius's reasoning for going with CMMI?
GL: We thought that the particular collaboration that we were going to get ... [would be] a very positive experience. The folks at CMMI are focused on our success, and they want to help us provide a better service to the elder population at a reduced cost.
We have almost all of our practice sites NCQA Level III accreditation for medical home. It's not that we're going one route or another. We're open. We conceptualize ourselves as an ACO across the board.
FH: Another reason that some organizations have passed on ACOs under CMMI are the legal hurdles. What was Atrius's experience?
GL: To my pleasant surprise, one of the major benefits when it comes to the Pioneer ACO organizations are waivers that diminish the difficulty to collaboration between us and other affiliated organizations. That was an added bonus. There are clearly federal HIPAA regulations and privacy hurdles, and there's a legal structure that you have to have in place; the ACO needs a board that needs to be composed of some Medicare patients. We didn't find them particularly onerous to do.
FH: It's still early, but what outcomes has the Atrius ACO seen so far?
GL: So far, the outcomes have been mostly operational for us. It's led to an increased pace of development programs for the frail elderly. We've been very focused on constructing nursing programs that tend to the community, and have been focused on improving collaborating with visiting nurse associations. We are putting into place roster reviews of Medicare patients in all of our primary physician practices and set up mechanisms to ensure the fact that we're meeting the needs of patients.
It's been like quickly packing for a trip that you're unexpectedly taking. There are lots and lots of details that we would like to have in place in production. We're expecting it'll be at least mid-year before we're completely deployed in the way we think we'll begin to yield results.
FH: Will ACOs work, and what are your plans for the future?
GL: The big experiment here is, can you provide managed care--the benefits of global payment--to a person who has choice, who isn't legally attributed to your practice?
Medicare is the world's largest PPO. Patients can move around in the network and get care from anyone they want to. The major stumbling block to global payment arrangements, risk arrangements, in the PPO environment has been the inability to attribute individuals to practices.
What's ingenious about the Pioneer ACO is that it gives the mechanism to do that. We've begun the conversation with commercial insurers. If we're doing this in the Medicare arena, why can't we do this in the commercial environment, as well, and then be rewarded for the benefit we bring to the reduction in total expenses in Medicare PPO patients?
Before, we were limited to the fee-for-service revenue that would be associated with caring for those patients. So this opens up a whole new vista in healthcare finance when we are looking for new ways to fully fund the programs of care that we want to offer.
I'm very encouraged by that and hope that these conversations with our commercial payers ... will catch on and we'll just expand on this new direction.
It's really breakthrough thinking and requires a lot of coordination between the payer and the provider. I'm optimistic over the next couple of years that we'll see a real growth in the expertise necessary to make this benefit.
Editor's note: This interview has been edited for length and clarity.