COVID-19’s deadly emergence was the health care story of 2020, but recently released results showing how the accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) last year managed to deliver high-quality care amid a pandemic certainly merits attention.
A significant chapter in that story is the way the physician-led ACOs belonging to the Privia Quality Network delivered high-value, cost-efficient care to patients in Georgia, Maryland, Texas, Virginia and the District of Columbia.
“We're committed to value-based care and we believe that we'll be at risk for most of our populations in the next five or 10 years,” said Keith Fernandez, MD, CEO of the Houston-based Privia Quality Network South Texas. Dr. Fernandez also is chief quality officer of Arlington, Virginia-based Privia Health—a member of the AMA Health System Program.
“When you take care of people that way—where the fee-for-service type payment isn't immediately connected to someone's care—then the only thing you need to do is make sure that patient does well,” said Dr. Fernandez. “This thinking changes your focus. And it's not that I make a living by seeing patients. It's that I make a living by taking really great care of patients. And I think this pandemic actually helped us figure out that that's quite possible to do.”
The Centers for Medicare & Medicaid Services (CMS) reported that MSSP ACOs earned performance payments totaling almost $2.3 billion while saving the Medicare program $1.9 billion in 2020. Privia’s MSSP ACOs delivered care to 121,000 Medicare beneficiaries and generated shared savings of $86.5 million.
Since 2014, Privia’s government and commercial ACOs have generated total shared savings of more than $576 million, with more than $281 million of that amount delivered by its MSSP ACOs. Privia Health has its own advocacy team that works with the AMA and others to engage with CMS to improve the ACO program. A recent AMA effort involves urging CMS to not use 2020 data to establish performance benchmarks for certain ACOs.
If your physician practice is thinking about joining an ACO, here’s what you need to know.
Dr. Fernandez said that Privia’s team of “brilliant data scientists and actuarial support” help identify the patients who are most likely to need medical care and physicians are alerted if intervention appears needed.
“It’s all about access to your doctor—that's the primary tool that we use,” he said, adding that access can in person, virtual or at home.
Fred Taweel, MD, agreed. He is chief medical officer of the Privia Medical Group-Mid Atlantic and chair of the Privia Quality Network board of governors.
“We want to keep our patients out of the hospital and as healthy as possible and that's what our job is,” Dr. Taweel said.
Having a team of “great, motivated docs” and appropriately aligned incentives with payers makes it possible to do this job well, added Dr. Taweel, an internist who sees patients at Internal Medicine Associates of Reston, a primary care practice in Reston, Virginia, where he is the managing partner.
Read more about how Privia succeeds by letting doctors be doctors.
Physician leadership is key to Privia’s ACO success. This includes using a dyad model where Privia executives are paired with a physician who provides input on business decisions and major technology purchases. Learn more about the company’s model at the Privia Health website.
Companywide, Privia physician leaders meet to discuss issues at its National Physician Advisory Council and regionally or locally through physician-organized delivery meetings. These groups have worked on issues to improve workflow by establishing the use of one EHR that identifies gaps in care, providing coding assistance and making scribes available to physicians who want them. The scribes work from recordings of the patient encounter, so they are not in the exam room at the time of the visit, Dr. Fernandez noted.
Dr. Taweel credits the strength of Privia’s diabetes-management processes for a significant part of its ACOs’ success.
“Diabetes impacts many of our patients and the cost of care more than any other single disease out there,” he said.