Make it through the challenges of forming an accountable care organization (ACO) for just a couple of years, and the money your groups save can be spectacular — into the millions under the right circumstances.
UPSA — an ACO of nearly 30 practices and around 80 physicians in San Antonio, New Braunfels, and Castroville — is living, saving proof.
In 2014, after nearly 15 years as an independent practice association, UPSA became an ACO and began participating in a Medicare Shared Savings Program. Two years after that, it enlisted the help of TMA PracticeEdge, which brings practices together to form and maintain physician-led ACOs. TMA PracticeEdge and its strategic partner, population health management group Innovista Health Solutions, helped UPSA hit its shared-savings quality targets and net an eye-opening result for 2017: nearly $2 million in shared savings.
“We have a good core of physicians, and the [number of] physicians on board is growing all the time, because more and more people are learning about ACOs and wanting to be involved with ACOs,” said Lloyd Van Winkle, MD, president of UPSA (Left). “Ultimately, nationally we must build a financially healthy primary care medical community that is able to provide high-quality, evidence-based care at reduced cost to our growing population. ACOs can help make that happen.” Naturally, the difficulties inherent in getting multiple independent practices to collaborate was a challenge early in the game, as Dr. Van Winkle notes.
“The first two years was figuring out what in the heck we were doing,” he said.
There were federal government ACO regulations, as well as local contracting considerations, to learn and leverage.
“We have an incredibly high penetration of diabetes in this population, and it’s challenging to manage that population,” said Dr. Van Winkle, a family physician at Medina Valley Family Practice in Castroville. “So when a national carrier compares our performance to the performance of a group of patients who are around St. Louis, Missouri, it’s a different population, and it makes it more difficult to compete. So if you can get them to compare to your community, it’s a lot more realistic.”
He says linking up with TMA PracticeEdge gave UPSA the management tools it needed to perform data analytics and to learn which areas of its practices need improvement.
The pooled resources of an ACO also offer advantages that many independent practices don’t enjoy.
“We had a meeting last night where we were talking about buying retina scan devices so we can get all our diabetics’ eyes examined. So there are things we can do as a group that are not necessarily possible as just an individual,” Dr. Van Winkle said.
“The group approach reduces cost as well, and that’s what we’re after: cost savings, and at the same time quality improvement. That’s what ACOs are all about: improving quality while reducing cost.”
This year, UPSA is hoping to save “a little closer” to $3 million, Dr. Van Winkle says. While a lot of an ACO’s shared-savings success depends on the doctors involved, he says, some of it also depends on some things physicians can’t control: the weather.
“I know that sounds odd, but for example, we’ve had a terrible flu season. That increases hospitalizations; that increases cost,” he said. “And we had a hurricane, and that changed things in a lot of markets as well, and we’re one of the impacted counties. So there’s a lot of factors at play, and you have to hope that all the stars align so that it comes together successfully for you.”
What is TMA PracticeEdge?
INTERESTED IN JOINING or starting a physician-led accountable care organization? TMA PracticeEdge has expanded to serve more than 600 physicians across Texas, allowing independent practices to pool
resources and providing the leverage needed to participate in value-based care contracts with all major payers in the state. For more information, visit www.TMAPracticeEdge.com or call (888) 900-0334.
Joey Berlin is associate editor for Texas Medicine. You can reach him by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; or by email.
Tex Med. 2018;114(3):10