'Completely Independent' ACO's Physician Leader Shares Its Story

CMS' recent announcement of 89 new accountable care organizations participating in the Medicare Shared Savings Program included Manhasset, N.Y.-based physician network Beacon Health Partners.

"In order to survive it made sense for us to come together and form a physician network — we needed to embrace ACO principles," says Simon Prince, MD, a nephrologist and the president of Beacon Health Partners.

Here, Dr. Prince shares insight into Beacon Health Partner's ACO and its plans for advancement.

The skinny on Beacon's ACO
Dr. Prince says the idea to become an ACO started in 2010. He wanted to find a way to remain independent in the wake of the recently signed Patient Protection and Affordable Care Act and embraced the concept of ACOs, unaware of what the organizations would look like.

"Right in the wake of legislation, we formed an independent physicians association with the thought that we wanted to get into accountable care," Dr. Prince says.

In January of 2012, Beacon Health Partners sent CMS a notice of intent and, six months later, became a Medicare ACO.

What distinguishes Beacon
A majority of ACOs are hospital-driven, though the number of physician-led ACOs is increasing nationwide at a higher rate than those with hospitals in charge, according to a recent Leavitt Partners report. Dr. Prince says Beacon's ACO configuration is different than even other physician-led organizations in that it is made up of independent physicians.

"One of the biggest things that makes our ACO different is that we're not associated or owned by a hospital or insurance plan; we are a collaboration of private practices," Dr. Prince says.

According to CMS, Beacon Health Partners is comprised of networks of individual ACO practices, with a total of 261 physicians.

Dr. Prince and other Beacon executives have been working to get all the independent practices moving in the same direction. He says it helps to "have a great group of doctors who are motivated, engaged and revving to go."

The ACO's relationship with hospitals
Beacon Health Partners has a large patient population it needs to manage, Dr. Prince says. In turn, partnering physicians have good relationships with area hospitals.

"Discussions about how to coordinate care and plan discharges and post-discharge follow-up care has already started," Dr. Prince says.

"It's in our interest as free agents to maintain strong working relationships with many of the area hospitals, not just one," he adds.

Challenges of being completely independent
While Dr. Prince says he enjoys the freedom of running an independent network of physicians, he adds that there are some challenges flying without the help of a hospital or system.

"Despite all the challenges, we strive to allocate our resources wisely and constantly educate and communicate with our growing ACO patient population," Dr. Prince says. "Furthermore, we are in the process of creating new communication channels with strategic partners, including care coordination, disease management and home care services. Beacon’s executive leadership moves closer to achieving these goals as quickly and efficiently as possible."

Dr. Prince notes the challenge of communicating ACO details to patients and partnering providers. The task is potentially more difficult for independent physicians than it is for a health system with experience in large-scale communications.

Additionally, Beacon Health Partners is dealing with the challenge of managing an ACO population, as are other new Medicare ACOs.

"We're in ramp-up mode. We're actively looking to grow infrastructure to handle this," he says. "Fortunately, there is a great deal of enthusiasm among our member physicians and we already have several third-party options on the table."

He says Beacon Health Partners is taking early steps to accomplish the goal of reaching Medicare beneficiaries assigned to them in their new ACO.  

Transforming for non-Medicare patients
The goal of Beacon's ACO is to bring the new care delivery model to a wider network of patients and to also bring on potentially new payor partners.

"This is a philosophy that helps to jumpstart our initiatives," Dr. Prince says. "We want to treat all our patients as if they were part of an ACO."

He says that the desire to deliver high-quality care while managing patient populations at a lower cost should be a goal that extends beyond an organized group of patients formally assigned to an ACO.

"We need to take this, run with it, and execute and broaden the reach to all our patients and tell a compelling story to all stakeholders," he says.

More Articles Related to ACOs:

'Absolutely Important' That Physicians Lead ACOs Says California Medical Association VP
Cigna Launches New ACO With Denver Physician Group
What Role Do Pharmaceuticals Play in Accountable Care Organizations?

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