10 People to Know in the World of ACOs

Don Berwick, MD, CMS administrator, Baltimore. Dr. Berwick has become a major player in the ACO world by virtue of overseeing implementation of Medicare ACOs at CMS. The agency is expected to release draft regulations on ACOs by the end of the year. Speaking at a joint federal listening session on ACO regulation with stakeholders on Oct. 5, Dr. Berwick showed a great deal of enthusiasm for the new concept. "It's not the status quo repackaged, it's a new and better way to organize care," he said. Dr Berwick is expected to use a new Innovation Center with $10 billion in funding from the healthcare reform law to test the effectiveness of ACOs and other strategies.

Lawrence P. Casalino, MD, chief of the Division of Outcomes and Effectiveness at Weill-Cornell Medical College, New York. Dr. Casalino was a pioneer in the ACO field, having coauthored the 2007 paper, "Accountable Care Systems For Comprehensive Health." He has envisioned a broad range of ACO models focusing on physicians. As a panelist at the Oct. 5 listening session, Dr. Casalino noted there has been a decline in managed care risk-contracting and the formation of large primary care-dominated multispecialty groups, but he added that the advent of ACOs may reverse that trend and "that could be a good thing."

Susan DeVore, president and CEO of Premier healthcare alliance, Charlotte, N.C. Ms. DeVore was the driving force behind organizing Premier's Accountable Care Organization Readiness Collaborative, which includes 40 health systems so far. "ACOs are a departure from the status quo, and will be an ambitious goal for even the most advanced healthcare systems," Ms. DeVore said in August. "Together, health systems in the ACO Readiness Collaborative will build the knowledge and expertise needed to transform today's system from one that treats illness to one that delivers health and wellness."

Elliott Fisher, MD, director of population health and policy at the Dartmouth Institute for Health Care Policy and Clinical Practice, Hanover, N.H. Dr. Fisher is said to have developed the concept of ACOs from an conversation at a 2006 meeting of MedPAC. Having documented large geographical variations in care in the Dartmouth Atlas of Health Care and demonstrated that more care does not equal better outcomes, Dr. Fisher came up with ACOs as a way of partnering providers to take on responsibility for the care of specific populations of patients.

Paul Keckley, PhD, executive director of the Deloitte Center for Health Solutions. Mr. Keckly has testified before Congress on innovative healthcare structures and recently facilitated a series of meetings for the White House Office of Health Reform with AHA, AMA and other stakeholder organizations discussing ways to reduce costs without compromising quality and access. A recent paper from the Deloitte Center, "Accountable Care Organizations: A New Model for Sustainable Innovation," addresses many aspects of ACOs.

Eric Nielsen, MD, chief medical officer for the Greater Rochester (N.Y.) Independent Practice Association.
Dr. Nielson, who is also a vice president at the Camden Group, has been leading his IPA, 843-physician GRIPA, affiliated with two hospitals, toward clinical integration. The IPA, which consists of independent and employed physicians, won a favorable advisory opinion from the FTC for sharing clinical and charge information in 2007. The IPA has developed clinical guidelines, an IT infrastructure for information-sharing and systems for monitoring physician performance.

Lee Sacks, MD, president of Advocate Physician Partners, Oak Brook, Ill. Dr. Sacks, also executive vice president and CMO of 10-hospital Advocate Health, has been building an integrated system with independent and employed physicians at Advocate hospitals for 6-7 years. Advocate recently announced an agreement to start a kind of private-payor ACO with Blue Cross and Blue Shield of Illinois. Under a three-year contract, Advocate will limit rate increases to the insurer in return for sharing in savings created by meeting performance targets tied to the quality, safety and efficiency of care.

Dana Gelb Safran, senior vice president for performance measurement and improvement at Blue Cross Blue Shield of Massachusetts, Boston.
The company is a pioneer in private ACO arrangements, having launched its Alternative QUALITY Contract program in Jan. 2009. The AQC program now covers one-fourth of Blue Cross' HMO provider network and 33 percent of membership. More than half of provider organizations in AQC are comprised of small practices with one to five physicians. Blue Cross sets a global budget for the provider that will be used later to determine extra payments for reducing costs.

Stephen Shortell, PhD, dean of the School of Public Health, University of California, Berkeley. Dr. Shortell has been promoting ACOs since co-authoring the seminal 2007 paper on the concept with Dr. Casalino. In an interview last year, Dr. Shortell said ACOs are meant to include a hospital, and specialists, and perhaps also nursing homes and other outpatient facilities, "but they're based on primary care." He added: "The key is moving away from fee-for-service and instead creating incentives for keeping people healthy."

Brian Silverstein, MD, senior vice president at the Camden Group, Chicago. Dr. Silverstein, who has more than 15 years of experience in the healthcare industry, set out to study ACOs shortly after they were introduced in the healthcare reform bill. He believes hospital-physician collaboration is crucial for ACOs. "Hospitals can no longer be removed from the rest of the healthcare continuum and will have to link up with physicians in particular," he says. He cautions that many healthcare providers are not prepared for ACOs and thinks it could take years for other providers to get up to speed.

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