Payment & Delivery Models

Physician leaders propel Privia ACOs’ perennial high performance

Andis Robeznieks , Senior News Writer

Physician-led accountable care organizations (ACOs) have consistently been ranked among the best-performing organizations in the Medicare Shared Savings Program (MSSP). The ACOs that collectively constitute Privia Quality Network are among the best of those.

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Internist Zia Khan, MD, who leads an independent practice in Peachtree City, Georgia, credits much of that success to the data tools and administrative support that Arlington, Virginia-based Privia Health provides. But the nature of independent private practices—with their long and deep connections with patients—should also get credit.

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Zia Khan, MD
Zia Khan, MD

“Our physicians, most of them are in independent practices that have very strong relationships with their patients for years and years,” Dr. Khan said. This includes long-time patients inherited from her physician mother, and when she talks about what they need to do to control their blood pressure or lower their A1c level, they’re able to have meaningful conversations about it.

“There's a rapport that I’ve developed with them over the years, and so they're more apt to listen, understand, and make changes and work with me to help treat their disease and conditions better,” she explained.

As a young girl, Dr. Khan would visit her mother’s internal medicine practice after school and noticed the connection her mother had with her patients.

“She knew their stories, birthdays, and anniversaries,” Dr. Khan wrote on the Privia “inforMD Blog.” “It was like they were extended family, which, in a way, they were.”

It was a connection Dr. Khan said she missed when she practiced in a hospital primary care department, so she went back and worked with her mother. But her mom’s paper charts were somewhat overwhelming to deal with, and administrative burdens were a distraction from clinical practice.

After discussing it with a like-minded independent local physician, Dr. Khan joined Privia Medical Group—Georgia. She now leads the five-physician, three-nurse practitioner, three-location Peachtree Medical Center.

Dr. Khan is also chief medical officer for Privia Medical Group—Georgia, the state’s highest performing MSSP ACO, which generated more than $23 million in savings in 2022.

About 30% of the ACO’s savings share was invested in its infrastructure, with another 10% invested in redesigning care processes and 60% distributed among the ACO’s participating practices.

The seven physician-led ACOs in Privia Quality Network generated savings of almost $132 million in 2022 as they provided care to 163,000 Medicare beneficiaries. Expenditures were 8% lower than the median MSSP ACO and 19% lower than fee-for-service Medicare.

Among all MSSP ACOs, the program saved Medicare $1.8 billion in 2022 compared to spending targets for the year, according to the Centers for Medicare and Medicaid Services.

Since 2014, Privia Quality Network has delivered total shared savings across government and commercial ACO programs of more than $890 million, including more than $510 million through participation in the MSSP. The amount of Medicare MSSP health care expenses included in Privia Quality Network has grown from $111 million in 2014, to $1.8 billion in 2022, according to a Privia news release.

The numbers for 2023 will be even greater as two more ACOs, from Delaware and North Carolina, were added to the network last year. They joined the other Privia ACOs comprising practices located in California, Florida, Georgia, Maryland, Montana, Tennessee, Texas, Virginia and the District of Columbia.

Peer accountability, collective decision-making and physician governance make the difference, said Dr. Khan.

“Physician-led ACOs are made up of a strong, independent primary care base that makes it easier for independent physicians to focus on quality measures and metrics like decreasing hospital admissions and ER visits,” Dr. Khan said. “There's really no conflict, as compared to a hospital-led ACO.”

Privia physicians meet regularly in local physician-organized delivery units to discuss population health programs and payer contracts, compare performance data and discuss mutual pain points.

“We look at which physician is doing better, say maybe in colon-cancer screening, and discuss why and we hold each other accountable—and I think that is really key,” Dr. Khan said. “Doctors listen to doctors, doctors understand each other, and that's really the magic sauce.”

In addition, Privia’s business infrastructure reduces distractions.

“When the practice is running in a very healthy manner, I can step back and focus on the clinical needs of my patients—that has been a key to our success,” Dr. Khan said.

“Now instead of seeing 30 patients, I can see 15 and spend time with my patients because I'm not forced to have to see 30 patients in order to keep the lights on and take care of my employees and other physicians in the practice,” she added.

Learn more with the AMA value-based payment best practices playbook.