Medical Groups Initiating Care Network
Pinehurst Surgical Group and Pinehurst Medical Clinic have joined forces to start an accountable care organization (ACO) that they hope will transform delivery of health care in Moore County.
Such organizations are small in number nationwide but growing as the health care industry struggles to rein in costs but improve care.
In accountable care organizations, health providers are rewarded not for higher utilization - more tests, more visits - but instead for how healthy patients remain. The emphasis is on quality and efficiency of care.
"Our current system is not sustainable, so we must change the way we work," said John Rezen, CEO of Pinehurst Surgical. "We can't overemphasize our desire to have everyone join us, because a communitywide effort is required. I would hope the hospital and the physicians in the community would agree that this is the direction we need to be heading.
"It's all about collaboration and working together to develop a better health care system."
Under an ACO, patients still see their own doctors, but wellness visits become more important.
The model gives doctors and hospitals a spending target for patient care and allows them to keep some of the savings if they come in under budget. Eventually, they also will be penalized if they spend too much. The organizations must meet certain health care quality standards.
In theory, with a stake in the finances, health care providers will find ways to avoid needless spending -such as repeated diagnostic tests - and will emphasize wellness over treatment by focusing on preventive care.
David J. Kilarski, CEO of FirstHealth of the Carolinas, lauded the move but did not commit the county's largest employer.
"We are pleased that Pinehurst Medical Clinic and Pinehurst Surgical remain committed to delivering the highest quality patient care at a better value," Kilarski said Thursday. "FirstHealth and the medical community have been on the forefront of responding to the Affordable Care Act with a number of initiatives to continue providing outstanding health care to the population we serve.
"High quality care, cost containment and patient satisfaction are achievable with cooperation and communication among all providers."
The medical practices announced formation of the Pinehurst Accountable Care Network in a half-page advertisement in last Sunday's Pilot, even though they are still developing a budget and addressing key issues such as computer technology.
"We're being transparent," Rezen said. "It's a very new initiative, and there aren't a lot of good examples of proven systems out there. There's a lot of culture change required to make it work."
Jim Faircloth, CEO of Pinehurst Medical, said the initiative is a joint venture.
"We're not merging," Faircloth said. "We've had an informal relationship with Pinehurst Surgical over the years. We agree that we have to adapt to the ever-changing health care landscape. It's challenging, but we're laying the foundation right now."
Added Rezen, "We already share a lot of patients, so it's a natural step for us."
The number of ACOs has increased significantly in recent years and is expected to grow even more quickly in the immediate future, with physician practices like Pinehurst Surgical and Pinehurst Medical under increasing demand to lead or participate in them.
Oliver Wyman Group, a consulting firm based in New York, reported last November that as many as 31 million patients in the U.S., or about 10 percent of the nation's population, are affected by the ACO model in some way.
This Medicare Shared Savings Program is part of the Affordable Care Act, also known as Obamacare, which the U.S. Supreme Court upheld by a 5-4 decision last June.
"We met for the first time last summer after the decision came down," Faircloth said.
Since then, a core group of Faircloth, Rezen and four doctors from each practice have met at least every other week to work over the details.
Rezen called it "a huge undertaking," one that will likely require a seven-figure investment.
"We are in the midst of developing our budget and formalizing our start-up plan," he said. "We want to encourage everyone to join us once we have the infrastructure set up. We really need everyone's participation to make it work."
According to the ad in The Pilot, the ACO will be open to every qualified health care provider and facility in the region "as long as they are committed to quality care, cost containment and patient satisfaction "
"Recent legislation has done little to change the reality that basic health care is growing unaffordable for many ordinary working families and individuals," the ad said. "In such an environment, perpetuating the status quo represents a disastrous choice."
Kilarski noted FirstHealth continues to "invest in systems to better manage and improve the health of our communities " such as the recent introduction of FirstCarolinaCare's Medicare Advantage product.
"We look forward to further engagement with our local physicians on initiatives to ensure we meet our goals of providing the highest quality care at the lowest possible cost," he said.
A report issued last December by the Commonwealth Fund found that investment in technology, particularly population health analytics, is a key success factor in implementing an ACO.
Other aspects of ACO readiness identified by the report include health system collaboration, clinical care integration, risk-based payments and strong leadership.
"This effort has to be physician-led," Rezen said, "and the patient is the focal point."
Any patient who has multiple doctors likely understands many of the frustrations associated with the fragmented, disconnected nature of fee-for-service health care delivery, whether they be lost or unavailable medical charts, duplicated medical procedures, or repeatedly having to share the same information with different doctors.
ACOs are designed to lift this burden from patients, while improving the partnership between patients and doctors in making health care decisions. And patients are not required to participate in an ACO; they can choose a physician outside the ACO.
Studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time.
"This initiative is about optimizing patient care. It's transforming from fee-for-service to fee-for-value," Rezen said. "It's an exciting time because this effort has so much potential to change health care for the positive."
Contact Ted M. Natt Jr. at (910) 693-2474 or tnatt@the pilot.com.
More like this story