Physicians Pioneering the ACO: 5 Thoughts From Dr. Gene Lindsey of Atrius Health

Written by Bob Herman | January 25, 2012 | Print  |
This past December, Newton, Mass.-based Atrius Health — the largest independent non-profit physician group in Massachusetts — was officially selected as a Pioneer Accountable Care Organization. In an effort to change the way patients and costs are managed in the healthcare system, Atrius Health is taking on a large responsibility — one that Gene Lindsey, MD, president and CEO of Atrius Health, takes very seriously. Dr. Lindsey, a cardiologist and internist, explains that 2012 is not just a big year for his organization. It's a year that will help define and shape where other physicians, physician groups and healthcare organizations are heading, and the ACO pilot program will be a core focus of Atrius Health's executive strategy.

Question: 2012 is going to be a big year for the healthcare sector, the second year of healthcare reform. What are some of the main organizational strategies, specifically with your orthopedics, spine, sports medicine and other significant medical specialties, you will focus on this year?

Dr. Gene Lindsey, CEO of Atrius HealthDr. Gene Lindsey: We are a Pioneer ACO, and we are focusing on creating the infrastructure for our Pioneer ACO activities. We'll be taking care of many elderly adult patients and populations where mobility and orthopedics will be key. When people aren't mobile, they lose their independence, and then they decline in other ways. We will be thinking critically how we deliver orthopedic and other kinds of care both in the office and in the home.

There is a large population over the age of 65, and there is a clear need to focus on large joint surgery programs. We prefer to have our orthopedic surgeons performing those procedures in collaboration with established hospitals. For the past few years, much of our practice has teamed up with New England Baptist Hospital [in Boston]. Data suggest that when we work collaboratively with other healthcare organizations, the total cost of care goes down. Additionally, the process of surgery and post-operative rehabilitation process is smoother, making the need for confinement in nursing facilities virtually nonexistent. That's a perfect example of the thinking we're trying to do — looking at the total cost of care and not the cost of individual segments of care. When you begin to look at how care is delivered and how it can be made more convenient and efficient, you're in a very interesting and innovative area that also improves quality.

Q: What care strategies do you think will work best for your organization?

GL: Our strategy over a period of several years is to move the practices back toward having most of our contracts as the equivalent of global payments. We follow the "Triple Aim" — high-quality care of the individual, improving the health of populations and doing it all at sustainable costs. We have to ask the question: Does our strategy add value? We've been at the process of trying to answer that question here for decades.

We were one of the original managed care organizations of the late 1960s, early 1970s and that continued up to early 1990s. As managed care became more of a "four-letter word," we switched to fee-for-service payment. We are trying to look at mechanisms that produce the benefit of global payments in a fee-for-service world. That's one of the great benefits of shared savings programs. We know there's a budget for the payment, there's an income opportunity and it's an ethical and legitimate way we'd like to be rewarded. Being rewarded with better outcomes is easy to say, but it takes a lot of alignment and coordination and change to create a system that's large enough and flexible enough to take care of a large population.

After operating in both environments, managed care and fee-for-service, the answer is the global payment environment. The world is one big opportunity at the moment. What other people see as a real challenge, we conceptualize it as our purpose. We're literally founded as a clinical innovation to explore the benefits of prepaid healthcare.

Q: Reimbursements and payor mix are especially going to be at the forefront of any healthcare organization. What are some of the ways you plan to navigate around decreased governmental reimbursements and a shifting payor model?

GL: Everyone is trying to figure out what pattern of reimbursement best fits what they do. We're in a period of uncertainty — hopefully a period of beneficial experimentation. The ACO, by name, is an experiment. It's looking to see whether you can have managed care outcomes in a patient population that has total choice with fee-for-service payments built in. That's an interesting experiment.

The exchanges will offer care to more and more people through prepayments like HMO products. This is going to stimulate new business opportunities for consultancies and organizations that have traditionally been insurance companies, like Aetna and UnitedHealth. For example, they can put together tools and best practices and become an "ACO in a box." They will come in and help providers who do not have the skills themselves understand data that are related to patients they are assuming risks for.

I think that once we get past this "resistance" and settle these issues — "Romneycare" versus "Obamacare" versus what we had — the main thing is the public wants something different. Some uncertainty will get settled this year, and you hope this energy you see right now will try to negotiate different [reimbursement patterns].

Q: How do you see the physician group transaction market playing out this year, both in general and within your organization?

GL: Our physicians are very much working as individuals less and less and as teams more and more. I think there will be consolidation of organizations. I don't know anyone who would think about setting up a solo practice of medicine. I don't know any group of 25 physicians that feels comfortable with the future.

Finding a combination of the right-sized practice for the right locality is a process that is going on — almost like speed dating — in the community. People are trying to match up with like-minded physicians with whom they are going into a relatively uncertain future. We're in period of shaking out, for sure.

We've chosen to accept the fact that change is going to occur. We can affect the way change does occur. We're a non-profit, and it has some specific advantages — the fact that we can have efficiencies of purchasing, and we don't have stockholders to make sure they get a return-on-investment. We measure efficiency as an organization in terms of the measureable impact toward moving our purpose in our community and the improved health of the community.

Q: If you had to give one piece of advice to another orthopedic surgeon, spine surgeon or physician group CEO — a piece of advice that is both practical but also provides hope for the future — what would it be?

GL: Ask yourself, "What strategy will move me in a direction that will prepare me to serve my patients better?" I think the mistake we all make is to think about our own needs. As healthcare professionals, if we're not patient-centric, we almost always take the wrong direction. In the long run, it's remembering we're here to care for patients. If [physicians] make choices not in the best interest of patients due to economics, we have a responsibility to address that. If patients are doing fine, it almost always turns out to be just fine. Think about everything from the point of view of the patients and if decisions add value to patients.

Related Articles on Physician Q&As:

Challenges and Opportunities in Complex Spinal Correction: Q&A With Dr. Krzysztof Siemionow

Spine Surgeons: Is An ACO in Your Future?

Will You or Your Group Participate in an ACO Arrangement in the Future? 5 Pain Management Physician Responses

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