As the saying goes – ‘if you’ve seen one accountable care organization (ACO), you’ve seen one accountable care organization.’ But while every ACO in our state is “homegrown” in its particular population and faces its own challenges as well as advantages, some transcendent lessons can be gleaned from each unique situation. Triad HealthCare Network (THN), based in Greensboro, for example, may be considered distinctive because of its relationship with the local hospital and employed physician network at Cone Health.
“Cone was masterful in their approach,” said Steve Neorr, vice president and executive director of THN. “Cone fully let physicians lead and drive this.”
The relationship between doctors and the hospital network, however, wasn’t always so trusting. Starting back in 2010, the real work began to create this successful partnership, which has proved itself through successful care management initiatives and shared savings through the Medicare Shared Savings Plan. THN was, in fact, the only ACO in North Carolina to exceed the threshold to achieve shared savings for the latest financial report from the Center for Medicare and Medicaid Services (CMS) in February 2014.
At first, though, it was just a group of three doctors who realized that health care as they currently were delivering it was not sustainable as to cost, access and quality. They believed that developing a local network based in the Piedmont-Triad area to serve patients and promote cost-efficient, high-quality health care across the broad provider community was key to the future of health care.
“Physicians have always been about quality and doing the right thing for their patients. That was an easy sell. The hard sell was we were telling them that now we were going to measure it,” said Thomas C. Wall, MD, the executive medical director at THN and one of the three doctors with the original vision for their community. “There also was a lack of trust between the hospital and doctors. It required a lot of relationship building.”
Wall and his colleagues set to work and initially chose 20 doctors, respected clinicians and leaders in the community who were willing to cross the old boundaries and open a dialogue with the hospital and other doctors. Three administrators from Cone also sat on the committee born out of dissatisfaction with the health care system status quo. Everyone agreed to check their egos at the door and have respectful, honest discussion, Wall said. Over hours of intense conversation, THN was born.
“It’s really a team effort,” Neorr said. “Having a hospital partner like Cone really made a difference for us. They have led the way in launching initiatives to keep people healthy and out of the hospital which is rather progressive for hospital systems. We believe strongly that Cone’s efforts combined with the efforts of THN Care Management to remove barriers to care and coordinate social services will equate to cost savings.”
Keeping people out of the emergency department and out of hospital beds runs counter to the assumed financial logic of hospitals, but THN has experienced willingness on the part of Cone Health to embrace this change as the right way to deliver care for the community. Wall envisions one day using the hospital for ambulatory health training centers for patients – perhaps a “Center of Excellence” for high-risk heart patients to learn about and practice preventive care for their disease.
“We need to get used to a different way of delivering health care,” Wall said.
THN currently includes 844 doctors with about 494 of those in independent practice and the remainder employed by Cone Health throughout the four counties the network spans. The model is physician-led with all physicians agreeing to set aside the specific interests of their own organizations and specialties and to work together to provide coordinated, patient-centered care. In addition, the network has partnered with THN Care Management (formerly MedLink) to provide results-oriented care management.
“We can provide someone to really listen; to build a relationship in the home, if necessary,” said Rhonda Rumple, RN, director of THN Care Management. THN Care Management receives 95-97 percent patient satisfaction ratings, and there are numerous stories of improved patient outcomes and cost efficiencies.
For instance, the patient who visited the ED 130 times in a year really just needed a way to get to doctor appointments for regular care. Working with the person’s landlord, the care management team was able to get a ramp to make the patient’s home accessible and to arrange transportation to and from the doctor’s office. The needless, high-cost ED visits ended.
Rumple’s team of pharmacists, licensed clinical social workers, and registered nurses use predictive software to analyze patient data and pinpoint their care management efforts to maximize their limited resources.
“Referrals [to THN Care Management] from providers have ballooned,” Rumple said, and Wall noted that it is considered a great asset to a practice. “Connecting patients to this community of care has so much value for these patients and our physician practices.”
The many hours of initial discussion have begun to pay off, although THN, like all ACOs, are still fledglings, and this model of care is still evolving. Every time information is shared between emerging ACOs new insights are gained and lessons learned.
“A lot of good work is going on around the country,” said Neorr, who joined THN in 2011. “It’s important to identify the right partners whose philosophy aligns with ours. Medicine is local.”