Providers take own direc­tion with ACOS

Modern Healthcare - - Front Page - Vince Gal­loro

Providers take their own path with ACOs in Cal­i­for­nia, Ten­nessee

Hos­pi­tals are cool to the CMS’ pro­posal for ac­count­able care or­ga­ni­za­tions, but providers in two states an­nounced last week plans for ACOs that aren’t de­pen­dent on the CMS frame­work.

Nashville-based St. Thomas Health is cre­at­ing a part­ner­ship akin to an ACO that will be rolled out in Jan­uary for hos­pi­tal sys­tem em­ploy­ees and their de­pen­dents—15,000 peo­ple to­tal, ac­cord­ing to a news re­lease. St. Thomas is a mem­ber of St. Louis-based As­cen­sion Health. Mean­while, in Cal­i­for­nia, an in­de­pen­dent prac­tice as­so­ci­a­tion and An­them Blue Cross, Wood­land Hills, an­nounced a con­tract that sets up a pri­vate ACO in Santa Clara County.

In Ten­nessee, the new Mis­sionPoint Health Part­ners will bring to­gether lo­cal care providers and na­tional tech­nol­ogy ven­dors. Provider par- tic­i­pants are St. Thomas, which has four hos­pi­tals and a stake in a spinal hos­pi­tal, and 200 St. Thomas-af­fil­i­ated physi­cians. Mis­sionPoint will use the telemedicine plat­form of San Jose, Calif.-based Cisco Sys­tems and will look to Ap­plied Health An­a­lyt­ics, Nashville, to pro­vide mem­bers with health-risk as­sess­ments and per­sonal health plans. Other Mis­sionPoint part­ners are Crim­son Ser­vices, an ini­tia­tive of the Wash­ing­ton-based Ad­vi­sory Board Com­pany that of­fers a physi­cian data an­a­lyt­ics plat­form to pro­mote bet­ter physi­cian per­for­mance, and the YMCA of Mid­dle Ten­nessee.

Mis­sionPoint is start­ing with a self-in­sured em­ployer pop­u­la­tion, but that’s only one of five pop­u­la­tions it in­tends to cover, CEO Ja­son Dinger said in an in­ter­view. The oth­ers are com­mer­cially in­sured, man­aged Med­i­caid, Medi­care ACO and unin­sured pop­ula- tions, Dinger said. By part­ner­ing with other area hos­pi­tals, Mis­sionPoint hopes to re­al­ize shared sav­ings from man­ag­ing the care of unin­sured in­di­vid­u­als, he said.

Once the in­fra­struc­ture is in place for man­ag­ing pop­u­la­tion health, it makes sense to ap­ply that in­fra­struc­ture to as many pa­tients as pos­si­ble, to spread the fixed costs over more cov­ered lives, Dinger said. “We re­ally be­lieve that work­ing with pop­u­la­tion health, you need to de­velop a plat­form for that and then be able to mod­ify that plat­form for dif­fer­ent pop­u­la­tions.”

Mis­sionPoint hopes to add 10,000 to 20,000 in­di­vid­u­als a year to its mem­ber­ship ros­ter, Dinger said.

An­them’s agree­ment is with the In­di­vid­ual Prac­tice As­so­ci­a­tion Med­i­cal Group of Santa Clara County, San Ma­teo, Calif. The pri­vate ACO, which is un­re­lated to the CMS ini­tia­tive to launch ACOs na­tion­wide for Medi­care pa­tients, is ex­pected to en­roll “tens of thou­sands of PPO mem­bers” who are al­ready pa­tients of the part­ner­ing physi­cian group, ac­cord­ing to an An­them spokes­woman. The physi­cian net­work in­cludes 284 pri­mary-care physi­cians, 550 spe­cial­ists and 10 acute-care fa­cil­i­ties.

— with Rich Daly

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