Across the country, Aledade’s physician-led Accountable Care Organizations (ACOs) are enabling primary care practices, clinics, and community health centers (CHCs) to stay independent, practice medicine like they’ve always wanted, and thrive financially while keeping their patients and communities healthy. In spite of a track record of success, however, many eligible primary care organizations have been reluctant to join an ACO because of fears related to the perceived “risk” of being held accountable for health care spending.
That hesitancy stems from the 2018 Pathways to Success Final Rule for the Medicare Shared Savings Program (MSSP). That rule pushed ACOs toward accepting more risk, faster, by limiting the amount of time an ACO can stay in the program without accepting at least some level of accountability for health care spending. For independent primary care organizations already struggling with limited resources, staffing shortages, technology challenges, and mounting administrative burdens, the fear of any possibility of risk can often outweigh the potential for financial rewards, leaving them hesitant to join an ACO.
As a result, the thousands of eligible, independent primary care practices, clinics, and CHCs that have not joined an ACO may have missed the opportunity to increase and diversify their revenue while enhancing the delivery of quality, coordinated care to their patients. Here, we examine two key understandings that primary care organizations should have about risk so they can make the most informed decision about their futures.
Primary care organizations can minimize risk by choosing the right ACO partner.
A 2018 Patient-Centered Primary Care Collaborative report identified characteristics of successful ACOs ready for the transition to risk: physicians in leadership roles; experience with value-based care; and a commitment to reducing unnecessary emergency room visits, emphasizing primary care and managing high-risk patients. The report further found that ACOs with higher proportions of primary care physicians are associated with better cost and quality outcomes.
Aledade’s model of physician-led ACOs is centered on these very tenets. Our model – and every tool and resource it encompasses – was designed by primary care physicians, for primary care physicians, to simplify the transition to value-based care as much as possible, so they can focus on the delivery of proactive, high quality care.
In addition to cutting-edge technology and timely, actionable patient data, we provide a local team of practicing physicians and clinicians, former practice administrators and office managers, nurses, and quality care experts to help primary care organizations of all sizes overcome obstacles and find success in value-based care. When these resources and tools are used effectively, primary care organizations can minimize the potential for risk and maximize the opportunity for reward.
Even in risk-based tracks of MSSP, the physician-led ACO model helps primary care organizations to achieve financial security so they can focus on their patients.
The data has yielded a resounding message about the success of physician-led ACOs. In fact, a 2019 analysis by Avalere determined that such ACOs are significantly outperforming their hospital-led counterparts in MSSP. They’re discovering higher savings the longer they participate in the program, and in 2019, on average, they produced nearly seven times the amount of Medicare savings per beneficiary than hospital-led ACOs.
The primary care organizations participating in Aledade’s physician-led ACOs are achieving similar results. In 2020, practices, clinics and CHCs in Aledade’s ACOs nearly quadrupled the national average in annual wellness visits and achieved a 40 percent increase in telehealth encounters, enabling these practices to earn an average of $198,000 in revenue from MSSP for helping their patients stay healthy.*
Our ACOs’ successes can be largely attributed to our collaborative focus on proactive, preventive care. By providing access to timely, actionable and user-friendly data at the point of care, the primary care organizations in our ACOs can make informed decisions about their patients’ care, conduct timely outreach to address care gaps, and better engage patients with complex conditions. As a result, they are improving outcomes for their patients while diversifying revenues for their practices and minimizing administrative burdens for their staff.
Is your practice ready to take the next step?
The shift from fee-for-service reimbursement to value-based care can be intimidating, especially when resources are scarce and success seems uncertain. At Aledade, we turn those pressures into clear and attainable opportunities for independent primary care organizations of all sizes to deliver high quality care, strengthen patient relationships, and thrive financially. In addition to being a trusted resource for the tools and support necessary for success in value-based care, our model offers customized downside risk potential and positions your practice to move toward the enhanced tracks of MSSP with confidence.
*Past performance is not indicative of future results.