Anatomy of an ACO

Modern Healthcare - - SPECIAL FEATURE - —El­iz­a­beth Gard­ner

Through its sys­temic ap­proach to qual­ity, Moun­tain States Health Al­liance has po­si­tioned it­self to have a re­gional role in the world of ac­count­able care. It has the only ACO in its mar­ket, A new Care Col­lab­o­ra­tive, which in July was ac­cepted to par­tic­i­pate in the Medi­care shared-sav­ings pro­gram. A fam­ily of or­ga­ni­za­tions cre­ates the un­der­ly­ing struc­ture of A new Care. They are:

Crest Point Health, a third-party health plan ad­min­is­tra­tor. Cur­rently manag­ing the health of all Moun­tain States em­ploy­ees (about 15,000 cov­ered lives), Crest Point will be con­tract­ing with A new Care as a payer. Crest Point also plans to of­fer stan­dard in­sur­ance prod­ucts for busi­nesses, and will launch a Medi­care Ad­van­tage plan for in­di­vid­u­als this fall.

In­te­grated So­lu­tions Health Net­work, the hold­ing com­pany of A new Care and Crest Point, is re­spon­si­ble for net­work de­vel­op­ment, provider cre­den­tial­ing and con­tract­ing. Moun­tain States is In­te­grated So­lu­tions’ par­ent com­pany and ma­jor stake­holder.

Blue Ridge Med­i­cal Man­age­ment Corp., a wholly owned for-profit sub­sidiary of not-for­profit Moun­tain States, man­ages the Moun­tain States Med­i­cal Group.

Moun­tain States Med­i­cal Group, part of Blue Ridge Med­i­cal Man­age­ment Corp., em­ploys about 400 physi­cians in pri­mary care and spe­cial­ties. The med­i­cal group is re­spon­si­ble for de­liv­er­ing pa­tient-cen­tered care and the de­vel­op­ment and de­ploy­ment of the pa­tient­cen­tered med­i­cal home from which the ACO mem­bers re­ceive care.

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