For Commonwealth ACO, Independent Physicians are the Foundation
The COVID-19 pandemic has spared no facet of the healthcare ecosystem, but its impact on small physician practices might have hit the hardest. As noted in a recent Kaiser Health News piece, “Although no one tracks medical closures, recent research suggests they number in the thousands. A survey by the Physicians Foundation estimated that 8 percent of all physician practices nationally— around 16,000—have closed under the stress of the pandemic. That survey didn’t break them down by type, but another from the Virginia-based Larry A. Green Center and the Primary Care Collaborative found in late September that 7 percent of primary care practices were unsure they could stay open past December without financial assistance.”
Undoubtedly, independent physicians are looking for a lifeline, and many have recognized that traditional fee-for-service payment environments aren’t sustainable in this chaotic healthcare landscape. To succeed in a value-based care and payment environment, while also remaining independent, however, these practices know they will need to be equipped with the right resources and technology.
To this end, Commonwealth Primary Care ACO, an accountable care organization in Arizona with 26 offices and more than 100 providers, has been committed to keeping its physicians independent. That’s why they recently announced they are partnering with Equality Health, a Phoenix-based population health risk management company, with the aim to empower their physicians with value-based care technology and practice transformation services.
Commonwealth leaders contend the ACO has a proven track record of providing high-quality value-based care through its participation in the Medicare Shared Savings Program (MSSP), recently ranking in the 94th percentile for quality. By partnering with Equality Health, Commonwealth aims to replicate key successes achieved in the MSSP in its value-based arrangements with Medicaid and Medicare Advantage plans.
Now entering its eighth year in the MSSP, Commonwealth’s CEO Lance Donkerbrook, says the organization started off “as a grassroots effort, with a bunch of local, independent physicians who were awarded an ACO, and then didn't really know what to do with it.” He explains that these doctors had long wanted to find a way for primary care physicians to collaborate, but most of their relationships were with specialists who they referred patients to, rather than with other PCPs. “So, very rarely did they have significant data or a meaningful process to help them put everything [about the patient] together,” Donkerbrook recalls.
As such, Commonwealth began to put the pieces in place by getting data from Medicare, which was a step above what the physicians had prior. Then over the course of the last several years, Commonwealth has found technology partners and other groups—spearheaded by Donkerbrook’s connections having previously worked in the technology and software development space—that either wanted to learn more about ACOs, or were willing to develop an analytics tool for the ACO space, for instance. “So we were able to cobble together a [data] infrastructure to help get us going and give us information that we've never really had before,” Donkerbrook recounts.
From there, Donkerbrook says the ACO hit somewhat of a turning point as the market shifted to more value-based arrangements and providers taking on risk. “So we needed to up our game, and up the level of tools and technology that we had for our providers. And while we've been able to put together some good tools for analytics, for clinical data, and for secure messaging, it's been enough to get us by, but at this point in time it's not enough to get us to the next level,” he acknowledges, admitting that still, “independent physician practices face a number of significant challenges in managing the transition to value-based care, including assuming greater financial risk and improving care coordination.”
A population health breakthrough?
Enter Equality Health, as Commonwealth's independent physicians will work with Equality’s management services organization (MSO), which offers clinical, technological, network, and financial management solutions that help make it easier for providers to profitably assume risk, officials say.
Lisa Stevens Anderson, president of Equality Health’s MSO division, notes that the tools and services that have been designed “have been purposeful to complement the primary care practices, not supersede them.” She further explains that the organization has developed technology that’s used by national payers, and there are instances of that technology for Equality’s provider contracts. “So we are standardizing the value-based workflow for those practices, [meaning] they no longer have to keep track of everything for 10 or 20 different contracts. By standardizing the value-based contracts, we standardize the value-based workflow through our technology to the practices, and that creates efficiencies within the practices that have very limited resources,” Stevens Anderson contends.
In addition to the technology, Equality’s care management resources are specifically designed to be extenders of the primary care practices and complement those services, Stevens Anderson adds. She notes that specific services include: pharmacy support, medication reconciliation and management, and a very heavy concentration on social determinants of health, with providers screening for SDOH.
What’s more, Equality also provides wraparound services with community health workers, social workers, chaplains, and a network of community-based nonprofit organizations to fulfill those needs that primary care practices can identify, but just lack the time or resources to follow up with each and every one of those patients. All these services are communicated back to the primary care offices, and through Equality’s technology, the primary care offices have visibility into everything that’s going on. “So, they go to that [data] when those members show up in their practices again. Everybody's operating off the same sheet of music,” Stevens Anderson says.
Donkerbrook says one key goal for 2021 in this area is to enable a consistent, yet simple process for Commonwealth’s physicians by bringing all different hospital and payer data together on a single platform through Equality, and have the ability to look at one source as often as possible. “So the [idea] is to not have to look on this tool for one payer, and another tool for a hospital system. That's not something that's going to happen overnight, but I think that as we can prove that this process is working and these tools with Equality are working, we'll be able to consolidate that more and more,” he says.
Working for the independent physician
Beyond the technology component, successful ACOs need to create a high-value culture and be true to their mission. For Commonwealth, Donkerbrook says that “the foundation for everything we do, and really the reason that we exist, is to support the independent physician.”
He adds, “Whenever we talk with our staff, or look at what the priorities are for the day, or whether or not we should do something, the questions that always comes back to us are: Does this benefit the independent physician? Does it somehow make their life easier, and does it benefit their patients in some way? That’s guiding force behind everything. From there, we want to be a champion for the independent physician throughout Arizona, and to be a model to share with likeminded organizations,” he says.
Stevens Anderson adds that Equality was formed first to provide a partner to and help independent practices be successful in the evolving landscape of value-based care, and second, to be that partner for payers that haven't invested the time to really understand what independent practices need to be successful. To that end, she notes, “What Commonwealth—a small organization of independent practices—has done in the last eight years, in this market of a lot of big gorillas, has been quite remarkable. The reason I believe that they've been so successful is because the providers are owners; they are invested in the success of the organization.”
