For Crystal Run Healthcare, a multispecialty group practice based in Middletown, N.Y., transitioning to an accountable care organization (ACO) was a chance to formalize a style of practice that its physicians had embraced for years. The 350-physician group, with offices spread across New York's Hudson Valley region, was a pioneer in adopting EHRs, employing care managers, and operating as a Patient-Centered Medical Home.
"When the healthcare reimbursement system started to change, we saw it as an opportunity to leverage the skills and capabilities we had developed over many years," says Scott Hines, Crystal Run's chief quality officer and physician leader for its medical specialties division. "We very much welcomed the chance to finally be rewarded on the basis of outcomes rather than transactions."
In 2012, Crystal Run was selected as one of the original 27 ACOs to participate in the Medicare Shared Savings Program (MSSP), which rewards organizations for lowering overall costs while meeting quality standards. The next year, it became one of the first ACOs to earn accreditation by the National Committee for Quality Assurance (NCQA).
"Becoming an ACO was about maintaining quality, improving our processes, and focusing on cost," says Jonathan Nasser, chief clinical transformation officer and physician leader of the pediatrics division for Crystal Run. "It was a perfect storm for us because it offered an opportunity to improve our efficiency while maintaining our financial sustainability."
As a medical home, Crystal Run already had many of the elements of an ACO in place, including team-based care, EHRs, and quality-reporting procedures. Still, the transition posed a variety of challenges as the group attempted to realign its physician compensation structure and engage all of its payers in moving toward value-based reimbursement.
GETTING STAFF BUY IN
The first step in the transition was getting physicians to buy into value-based care, says Hines. Providers attended orientation sessions in which they learned about the ACO concept and why it represented a better way to deliver care.
"In a fee-for-service system, an endocrinologist, for example, will get paid more for seeing 30 totally uncontrolled diabetics than 30 well-controlled diabetics who have good quality of life because they get paid more the sicker people are," says Hines. "We really wanted that message to resonate with providers."
Hines also explained that becoming an ACO would provide better long-term financial stability for providers and the practice, as more payers moved toward alternative payment models.