ACO Coalition Considers Primary Care Transformation

PLAINSBORO, N.J.—Primary care transformation will rely on the quadruple aim, which adds stakeholder engagement onto the traditional triple aim of better health, better care, and lower cost.

During the most recent Web-based session of The American Journal of Managed Care’s ACO & Emerging Healthcare Delivery Coalition, Sara Bolton, MPH, director of Programs and Services Operations at The Health Collaborative; Barbara Tobias, MD, medical director of The Health Collaborative; and Amy Mechley, MD, physician executive and assistant professor of family medicine at the University of Cincinnati Residency Program, discussed primary care transformation and provided a case study.

In order for the triple aim to be success, stakeholder engagement—providers, payers, and patients—is necessary. According to Tobias, engaged patients are the most important factor for making the triple aim successful.

Using a case study of a fictional patient, named Elizabeth, Mechley provided 3 different examples of practice transformation. There are 3 models: the traditional model, team-based advanced managed care model, and the consumer-driven model.

Under the traditional model, the patient pays a copay and only has 7 to 10 minute with the provider. These models typically do not provide any virtual care, email or text service, and the patient might have to wait 2 months for an appointment.

“Our current primary care traditional system may not be meeting the goals of where we’re looking at population health and that’s why we’re looking at transformation models,” Mechley explained.

Under the team-based advanced managed care model, the patient still has a copay and only about 7 to 10 minutes with the provider, but there is a team that can see and help care for the patient, and it is easier to get help over the phone.

The team caring for the patient under this model could include a registered nurse, care coordinators, and advanced medical assistants.

In comparison, the care under the consumer-driven model is very different. For one, the model utilizes the payment of a retainer, which is for improved access. “It solves the problem of being seen when they need to be seen by the primary care doctor,” Mechley said.

In this model, the patient has no copay and may meet with the provider for 30 to 90 minutes, plus extra services, such as virtual care, email, text, and phone, are all available.

According to conservative estimates over 17 years, an employee health plan using the consumer-driven model will save $245,000, plus there will be an additional 20% decrease in utilization. This model shows better outcomes, quality of life, and patient experience.

To hear more case studies, participate in workshops, and network with other stakeholders, attend the ACO Coalition’s fall live meeting in Philadelphia, Pennsylvania, October 20-21. To learn more and register, click here.

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, retail and specialty pharmacy, academia, national quality organizations, patient advocacy, employers and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT:

Nicole Beagin (609) 716-7777 x 131

nbeagin@ajmc.com

www.ajmc.com