ACOs are an idea whose time has come, according to Gene Lindsey, MD, president and CEO of Newton, Mass.-based Atrius Health.
A nonprofit alliance of six community-based medical groups representing more than 1,000 physicians and 1,425 other health professionals, Atrius Health serves nearly 1 million patients throughout Massachusetts. Atrius Health was chosen as one of 32 organizations to participate in the Pioneer Accountable Care Organization (ACO) federal pilot, begun a year ago.
Through the Pioneer ACO model, Atrius Health worked with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination. Prior to participating in the Pioneer ACO model, Atrius Health had been functioning as an ACO for many years, according to Lindsey.
Healthcare IT News’ Senior Editor Diana Manos caught up with Lindsey recently and asked him to share his thoughts on ACOs.
Q: How and why do you think Atrius Health began an ACO before it was pushed into doing so by a federal program?
A: Atrius is the legacy of Harvard Community Health Plan. Every aspect of it was like an ACO, and we have a long history of accepting risks. We felt very comfortable thinking of ourselves as an ACO, even before we were defined that way. By any definition, we meet the criteria. It was prompted by Harvard Community Health Plan founder Robert Ebert in 1969, who felt strongly that fee-for-service was fragmented and improperly incented medical activity. His thoughts on how to manage care focused on health and wellness and a global payment as a strategy that doesn’t totally break the budget.
Q: What are some of the challenges related to participating in an ACO?
A: Organizations have to put a lot of trust in the model to be financially sound so that they can be rewarded, and in the capabilities of the organization to perform in an improving fashion. You don’t go into an ACO mindset without expecting that change in behavior will be required. ACOs are predicated on innovation. Healthcare today isn’t a single-person activity. We have care teams, plus suppliers, who are not in the ACOs. Some of them need data support. We provide our own data support, but not for long-term care, and we don’t employ all the specialists that we use. Not only do we have to manage ourselves, but we also have to manage our suppliers and we have to incent them to cooperate. This takes an incredible amount of managerial capacity that folks have to learn how to do. It’s hard work.
Q: What do you think provides the impetus for organizations that want to participate in an ACO?
A: The motivation for doing the hard work and making the investment is the realization that the way we have been doing healthcare doesn’t work. Change is inevitable, and if it is, then we ought to accept that reality and discover it. I like the name Pioneer, [as in Pioneer ACOs]. It implies going someplace you haven’t been before, and there’s a certain amount of excitement associated with that. It takes forward-looking individuals, and those [who] master the skills necessary will be better off in the future.
Q: What do you think is a major benefit of ACOs?
A: Being more productive by leveraging your resources and eliminating waste is part of the ACO concept. We have to move toward common ideas. How do we share things? How do we judiciously use high-tech equipment so we don’t duplicate its use? We have to embrace that concept, and not use equipment just to justify its costs. We share highways and airways; we need a common approach to healthcare.
Q: What advice would you offer to other providers regarding healthcare reform and ACOs?
A: Divest yourself of self-interest and focus on the healthcare consumer. Try to do everything to optimize quality and value for the purchaser. You’ll be better off, because businesses succeed that offer better quality for lower cost. I think the ACO movement supports all of that. I hope we can keep these things in mind. It’s a good idea to be aligned with the patient community. The other way never works in the long run. I know this concept is difficult for some doctors who have practiced medicine a certain way for a long time. I am 67. I did all the things they did. This is a time of stress and change. It is the responsibility of professions to demonstrate leadership. If you’re going to be a professional, you need to focus on your customers, the patients. I don’t think anybody would be sorry for me if suddenly I were a failure because I didn’t focus on my responsibility. Doing things the right way makes sense.