Posted in Accountable Care, ACO, Affordable Care Act

The Accountable Primary Care ACO

By Gregg A. Masters, MPH

At the recently concluded 4th Annual Accountable Care Organization Congress held in Los Angeles one of the sessions I attended was offered by Tom Doerr, MD, Director of Innovation Research, and Deborah W. Robin, MD, MHCM, Medical Director, of Lumeris respectively, titled “New Hope for Primary Care: The Accountable Primary Care Model”.

 

Primary care physicians are central to the sustainable or accountable care ecosystem envisioned via tenets of the ‘triple aim’. Often laboring under payment systems that typically favor procedural vs. cognitive specialties and historically placed at the center of most so called ‘managed care’ plans, primary care physicians dubbed ‘PCPs’ have often been put on a hamster wheel of ‘productivity formulas’ i.e., 30+ patients a day with panels exceeding 3,000 patients. As a consequence this workload burden is literally driving many to exit ‘the system’ and opt for quality of life and income opportunities afforded via concierge, direct practice or retainer medicine models at the precise time when demand is expected to significantly outstrip supply courtesy of the Affordable Care Act.

Into this ‘diminishing returns continuum’ now consider the Lumeris philosophy, value proposition and approach to an accountable care vision, wherein one of the variations on the theme of the triple aim – improved experience of care, better population health at lower per capita costs –  is the ‘plus 1’ of physician satisfaction with working conditions associated with the delivery system. Finding a way to make primary care physicians both ‘productive’ and happy is a sweet spot that many health systems, IDNs or provider networks aspire to, but few effectively achieve.

As far as the playbook is concerned, a look under the hood at Lumeris via website copy reveals the following:

The Lumeris Accountable Primary Care ModelSM — or the Nine C’sSM for short — is a powerful, proven framework for delivering the Triple Aim Plus One: quality, cost, and patient and physician satisfaction. The Nine C’s help providers understand their risk and the fundamental process, workflow, and behavioral approaches that should be adopted as health care moves from a volume- to a value-based model.

Further as noted via the Healthcare Blog, Dr. Doerr sets context for the value proposition of this model to primary care physicians as follows:

Primary care has long been something of an outcast in the medical profession — and despite convincing outcomes and a validated assessment tool, checkered reimbursement has brought the Institute of Medicine’s Primary Care Model to the brink of demise.

But the accountable care movement, and some Medicare Advantage plans in particular, have breathed new life into primary care and offered new hope for the struggling Medicare system. At St. Louis-based Essence Healthcare, a 4.5-star Medicare Advantage plan, network primary care physicians’ deep experience in providing accountable care has spawned innovations that advance primary care and make progress toward the “Triple Aim Plus One” (outlined in C9 below). Their success is the result of five years of active practice transformation and continuous improvement in a risk-bearing environment.

For complete article review, see: ‘The Nine C’s of Successful Accountable Primary Care Delivery‘.

This clip is a highly edited version of what amounted to a 45 minute session including a brief Q&A. The end to end clip will be posted here and on HealthInnovation Media shortly.

 
About Lumeris

Lumeris is an accountable care delivery innovation company offering health systems, payers and providers operations, technology and consulting services. Our transformational solutions help health care organizations design, build, operate, measure and optimize any accountable care model to accomplish the Triple Aim Plus One: improved quality, cost, and patient and physician satisfaction. The depth and breadth of Lumeris’ solutions — combined with its extensive experience in accountable care — make the company an ideal partner for any health care organization seeking the benefits of a better connected, aligned and informed accountable delivery system. For more information, call 1.888.586.3747 or visit Lumeris.

Disclosure: The author received compensation from Lumeris to record this session.

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2 thoughts on “The Accountable Primary Care ACO

    1. Thanks Gary!

      As far as the financial question, you may want to reach out to either Drs. Doerr and/or Robin.

      If you apply their experience in terms of per diem, per case or per visit benchmarks to the reduction in key indices of utilization and thus cost, you can ballpark economic impact of the model.

      Beyond that, I do not know the details.

      Thanks for your comment!
      Gregg

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