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ACOs start the new year with a growth spurt that includes Indiana
e-Reports, Feb. 4, 2013
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Health care delivery in Indiana has entered an era of significant change, evidenced by growing numbers of accountable care organizations (ACOs) and entities. If you’re not part of an ACO, or have not yet felt their influence, it’s likely you will soon.

The year started with an ACO growth spurt after a federal announcement of 106 new Medicare contracts. That includes three based here in Indiana and another two, KentuckyOne Health Partners, LLC, and Owensboro ACO, LLC, based in Kentucky to serve patients in Indiana and Kentucky. That brings Indiana’s ACO count to around 10 and the national total to more than 250 since passage of the 2010 Patient Protection and Affordable Care Act.

The Indiana players are familiar. Franciscan Alliance is establishing a Medicare ACO partnership with Union Health System in the greater Terre Haute area, effective Jan. 1. Premier Healthcare in Bloomington joined with American Health Network to create the Indiana Care Organization LLC. The recently announced Indiana Lakes ACO, LLC, based at IU Health Goshen, has a separate charter and LLC than IU Health in Indianapolis.

In October, two large central Indiana health systems and six area Suburban Health Organization hospitals formed an “accountable care consortium,” (ACC) with the goal of improving quality and lowering the cost of health care. The ACC, which has its own board and CEO, is not connected to federal initiatives and all partners have equal ownership.

Franciscan Alliance and Cigna just launched an accountable care initiative for the Indianapolis area. Franciscan Alliance ACO includes more than 600 local physicians, five immediate care centers and hospitals in Indianapolis, Mooresville and Carmel.

News from the north

Larry Allen, M.D.
Larry Allen, M.D.

Leading the Indiana Lakes ACO, LLC, is ISMA member Larry Allen, M.D., chief medical officer of IU Health Goshen, who practices family medicine part time in Syracuse. Dr. Allen advised that 95 percent of physicians at the hospital signed up for the network, though it was not mandated.

Dr. Allen believes, “If physicians will lead this effort, we can be at the forefront of taking the best care of people in the most effective way. As physicians, we are being begged to lead this charge. So, if there’s ever been a time to be involved, now is the time.”

Gene Diamond
Gene Diamond

Gene Diamond, CEO of Franciscan Alliance, Northern Indiana Hospitals, noted, “We’re evaluating our ACO experience. Our sister hospital, Saint Francis in Indianapolis, led our system into the Pioneer ACO last January; preliminary results have been mixed to favorable.”

Diamond explained a time lag exists between the gathering of meaningful information and analysis of it to discern more fully how things progressed during 2012.

Jim Callaghan, III, M.D., president of Franciscan St. Anthony Health in Michigan City, also noted the importance of physicians, “You can be sure that we’ll depend on effective physician leadership to help us make ACOs work for our patients.”

Jim Callaghan, III, M.D.
Jim Callaghan, III, M.D.

Dr. Callaghan sees implications for patients, too. “I think the ACO movement will improve care of patients with chronic conditions.” He believes it will be important for physicians to embrace quality of care and cost-reduction initiatives to make care better and more sustainable from a cost perspective.

And further south

Ben Park
Ben Park, M.D.

American Health Network (AHN) is partnered in three ACOs, one with Franciscan St. Francis, the new one with Premier Health in Bloomington and another serving Ohio patients.

“We have just six months of experience with our Franciscan JV (joint venture) and it is going well. We do not have a lot of data yet, but what we have is encouraging,” said Ben Park, M.D., president of AHN.

One of the most valuable aspects of ACOs, said Dr. Park, is access to the entire claims history on nearly 30,000 Medicare patients, allowing AHN to understand variation in outcomes for different hospitals.

“As you might expect, no hospital is the best at everything,” he said. “As we learn more, we will be able to get our patients the best care by referring them to the hospital that is best for their condition. This is quite exciting and as a side benefit will save a lot of money by avoiding complications and readmissions.”

Dr. Allen agrees data is important. “Giving physicians data on their quality metrics really is a great tool to help them improve care. And teamwork among hospitals and physicians has to be at the heart of new efforts.”

What is an ACO?
Accountable care organization (ACO) - A clinically integrated network of physician groups or physicians and hospital(s) focused on managing patient care to meet cost and quality targets. Incentive dollars – from cost savings – are distributed for achieving those goals. ACOs maintain a strong primary care network, share patient health care information and adopt common treatment protocols. Under Medicare, an ACO must provide care for a minimum of 5,000 patients and participate for at least three years.
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