ACO and Patient-Centered Medical Homes: How One Organization Is Diving Into Both Models

DelmontManhasset, N.Y.-based Beacon Health Partners, an independent physician association made up of 90 independent physician practices throughout New York, began moving toward forming an ACO in 2010, shortly after the Patient Protection and Affordable Care Act first passed. The IPA was officially added as a Medicare Shared Savings accountable care organization in July of this year. This month, Beacon took another step to offer patients the most coordinated, dedicated care possible — it began the process to turn 60 of its independent physician offices into patient-centered medical homes.

Jacqueline Delmont, MD, is Beacon Health Partners' medical director and is leading the organization's charge toward PCMHs. She says that PCMHs work very well with and under an ACO model. "A patient-centered medical home tries to achieve at the physician practice level the same goals that an ACO is pursuing as an organization," she says. "Even if an organization isn't seeking certification [as a PCMH], the principles of patient-centered medical homes need to be adopted in order for the  ACO model to be successful, increasing patient access and satisfaction, improving the quality of care delivered and decreasing healthcare costs."
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"We see becoming an ACO as an opportunity to become a patient-centered organization," says Simon Prince, MD, CEO of Beacon Health Partners. "Building toward getting our individual practices certified as patient-centered medical homes is an important early step towards a broader initiative."

In order to become certified PCMHs, physician practices must prove that they meet certain standards laid out by certifying bodies, such as the National Committee for Quality Assurance. For example, practices must demonstrate that they have after-hours patient access and have linguistically appropriate services for its community. Those are just two examples of many standards that must be met in order to become a certified PCMH.

"The number [of physician practices] is ambitious," Dr. Delmont says. "We recognize the difficulty, but we have a team to facilitate the process to providers," she explains.

Dr. Delmont says that once the transformation process and appropriate changes in workflow occur in the physician practices, they will be able submit the application for NCQA recognition.

Strategies for PCMH success

While Beacon is still on the path to forming patient-centered medical homes, Dr. Prince and Dr. Delmont share some tips for success.

"It takes the right leadership, motivation and physician involvement," Dr. Prince says. "This is a big transition. It would be very difficult for practices to do it on their own, without investment from an organization."

"The leadership has to believe in the philosophical concept [of being patient-centered]," Dr. Delmont says.

Dr. Prince says it is important to put together a team to lead the transition to becoming patient-centered medical homes. "[Dr. Delmont] is uniquely qualified as a strong physician leader with the experience and tools necessary to execute on our organizational goals," he says. "We are excited about the team we have assembled and our network physicians as we embark in this journey."

Both leaders recognize that Beacon is in a different position than most organizations that might attempt to become patient-centered medical homes. "Other organizations are trying it with employed physicians," Dr. Delmont says. "We have independent physicians, so we have to get the physicians to buy in to the program and get engaged," she says.

Success as a new Medicare Shared Savings ACO

On top of working towards certifying physician practices as patient-centered medical homes, Beacon Health Partners is still striving to be a successful Medicare Shared Savings accountable care organization.

Since Beacon has only been an ACO for two months, Dr. Prince says one of the greatest successes to date is gaining acceptance into the ACO program. "The fruits of our labor have not yet been realized," he says. "But our future is very bright."

One of the biggest issues that Beacon faced on its journey to become an ACO was getting physicians on-board and involved. "Without physician involvement, we would fail," he says.

In order to get physicians on board, Beacon launched a campaign with multiple angles, such as dinners, meetings, emails and phone calls. Dr. Prince stresses the importance of personal relationships with physicians during the transition. "It takes time, energy and education," he says.

Overall, he says that success as an ACO is possible with physician engagement, strong leadership and the right infrastructure and resources.

More Articles on Patient-Centered Medical Homes:

WellPoint's Patient-Centered Medical Home Pilots Meet Some Cost, Utilization and Quality Goals
Hospital and Health System Strategy for 2013 and Beyond – Do Your Strategies Match or Beat Your Competitors'?
New York Payor CDPHP to Double Medical Home Program

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