A physician-led accountable care organization is the subject of a New York Times Op-Ed piece penned by Farzad Mostashari and Dr. Bob Kocher. It illustrates the kind of turnaround in patient health that the former head of the ONC for Health IT hopes to help primary care physicians achieve. Mostashari is the co-founder and CEO of Aledade, which provides an ACO toolkit to help physicians set them up. Kocher, former Special Assistant to the President for Health Care, is a partner at Venrock, which is an investor in Aledade.
What’s interesting is that the high medical costs and poor medical outcomes in one of the Texas towns where Rio Grande Valley ACO’s medical clinics are based — McAllen — was the linchpin for what became the Affordable Care Act. A system that rewarded physicians the more procedures they did rather than for patient outcomes, made the city one of the most expensive places in the country to get healthcare with the worst patient outcome record, according to a New Yorker article the opinion piece references.
The ACO saved more than $20 million from its Medicare baseline from 2012-2013. It achieved those results, in part, by increasing the number of patients who could successfully control their diabetes from 36.5 percent to 43.8 percent in that one year time frame, the article said. The number receiving vaccinations rose by more than 12 percent in the same period to 93.3 percent. Those numbers include not just McAllen, but the ACO’s entire practice, which covers 16 clinics in the Rio Grande Valley.
The article champions four ways Rio Grande Valley ACO supports the shift to outcomes-based care.
Who are the high risk patients and what do they need? Doctors analyzed data from their electronic health records to determine who the high-risk patients are to help figure out what they needed to improve.
Making it easier for patient to access care: If access to the doctor’s office was an obstacle, those patients were visited at home. The physicians gave mobile phones to patients vexed by communication problems with doctors.
Preventive medicine became central to care. Doctors advised patients about diet and lifestyle changes that could prevent future health problems, and developed personal care plans for patients with uncontrolled diabetes. They gave vaccines to patients who needed them.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Rapid follow-up after patient discharges: Patients who had recently been in the hospital were scheduled for follow-up appointments soon after they were discharged to check on their recovery and to identify potential problems earlier.
In response to emailed questions, a spokesman said Mostashari discovered Rio Grande Valley ACO when he was at the Brookings Institute and developing his idea for Aledade.
More than half of the 600 ACOs that have formed are physician-led ACOs, according to a survey by the Dartmouth Institute for Health Policy and Clinical Practice. Although they are still very much in the early stages of growth, Rio Grande’s example is encouraging. It will be interesting to see whether Rio Grande can continue the momentum and whether the exchange of best practices and tweaking their patient care delivery can help other ACOs to reduce healthcare costs and build viable practices in the long-term.
