ACO Plans: Scripps Mercy Physician Partners As a physician organization, Scripps Mercy Physician Partners (Partners) embraced the concept of ACOs before they were the rage. Partners’ primary mission is to help sustain private practice in the tumultuous world of San Diego medicine by reducing practice costs and by increasing revenue. Partners was formed as a messenger model IPA to offer substantially better fee-for-service contracts for its member physicians than those that could be obtained individually, and to provide a variety of options to decrease practice costs in the private office. The leadership of Partners, like others in the industry, recognized that the cost of medical care as currently provisioned was unsus-
After a period of deliberation within the organization, the concept of clinical integration won out over economic integration since most of our members wished to maintain full control of their individual practices. tainable. As physicians often bear the brunt of cutbacks disproportionately to other large and powerful players in the healthcare system, Partners investigated ways to at least maintain and hopefully improve physicians’ economic interests in the face of the forces that constrain physician reimbursement. After a period of deliberation within the organization, the concept of clinical integration won out over economic integration since most of our members wished to maintain full control of their individual practices. Clinical integration is an arduous task in the face of a multitude of private practices and the idiosyncrasies of solo and small-
group physicians. At first, a common electronic medical record and practice management system was considered as a means to achieve clinical integration, but this solution was quickly dismissed as a nonstarter due to the varied information-technology needs of members. Barriers to adoption, including cost, were also key in rejecting this course of action. In late 2008, physician portals, or hubs, were becoming popular on a national basis. Low-cost, subscription-based physician portals leverage the power and access of the Internet with the concept of data sharing in an easy-to-use format. This concept led to the creation of VIP Health Connect, a still-nascent health information exchange that currently offers integration with more than 400 practice management systems, e-prescribing with Allscripts, and HIPAA-compliant messaging. Further development of the portal’s capabilities, including lab and imaging reporting and EMR interoperability, will allow seamless medical information sharing, reduction in duplication, more efficient care, and hopefully better reimbursement for our physicians. Of course, our group recognizes that payers, both government and commercial, need to see the benefit of an IT backbone leading to an ACO before they share more of their funds with physicians. It follows that one mode of failure for the ACO concept is a lack of cooperation on the part of both private and government payers, or the institution of unattainable goals like those that permeate many pay-for-performance programs. As we see things today, the ACO concept is still pretty fuzzy. While ACOs are currently popular for the Medicare sector, their applicability to the commercial market is also very
intriguing. Nonetheless, several things are clear: 1. The driving force for the ACO concept is to manage cost while increasing quality from improved provider coordination. 2. Improved communications should benefit all parties. 3. We believe that technology can be utilized to share information, decrease unnecessary costs, and improve quality. 4. Risk and reward factors need to be clearly identified and well understood. 5. Our healthcare system is a pluralistic delivery system. 6. Physicians’ role in an ACO is significant. This substantial role needs to be accompanied by a major voice in governance. 7. The ACO is a collaborative effort requiring alignment and collaboration of payers, physicians, and hospital partners. Physician Partners group is actively sharing information regarding ACOs with our members. We continue to enhance the features and utility of our physician portal. We will continue to evaluate ACOs and other opportunities with the goal of improving the delivery of healthcare and maintaining the key role of physicians. Though still taking shape, we anticipate that Partners and its physicians will continue to play significant roles in the delivery system. The ACO is not the first effort to reorganize healthcare providers and, undoubtedly, it won’t be the last. Many previous efforts have failed and some have backfired. While the ACO may result in major changes for the healthcare delivery system as we know it today, success will certainly hinge on the inclusion of physicians in planning and acknowledging that patients and physicians need to be the center of the system.
About the Authors: Mr. Cracroft is president of Scripps Mercy Physician Partners, Dr. Couris, SDCMSCMA member since 2001, its vice president, and Mr. Steuer its executive director.
sept ember 2010 SAN DIEGO P HY SICIA N. o rg
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