32 organizations take part in CMS initiative to coordinate care

WASHINGTON - For the first time ever, healthcare provider groups and other organizations that have been focusing on lowering costs while improving care will be asked to lead the way, in hopes that others in their regions will follow suit.

The Centers for Medicare and Medicaid Services (CMS) are calling these organizations Pioneer ACOs, and there are 32 of them from 18 states. They started Jan. 1 on a journey the federal government hopes will save Medicare up to $1.1 billion over five years - while spreading the concept to private payers nationwide.

The Pioneers are required to engage other payers and abide by strict beneficiary protections as they improve care for as many as 860,000 Medicare beneficiaries, according to CMS officials.

CMS officials said they will use robust quality measures and other criteria to reward the Pioneer ACOs for providing better care at lower costs.

Brown & Toland Physicians in San Francisco was selected to be one of the pioneers. CEO Richard Fish said Brown & Toland has been building a type of ACO for the past ten years, so it was a natural step to apply to participate in the Pioneer ACO initiative.

“For our mission and values, it lined right up,” he said. “Our goal has been to support all our doctors for all of our patients, not just our HMO patients. We call it our all-product strategy.” Providing the doctors with feedback on their care is one of the ways Brown & Toland supports them.

The organization's 1500 or so physicians are independent, and the company coordinates the care among them. “It's not one big staff model,” said Fish. “We're using IT to knit all this together. It's giving us the capability of working as one large medical group.”

“Since we don't employ any of these doctors, we have a challenge,” said Mark Ficker, COO at Brown & Toland Physicians. “They're not under our control. We need to sell to them that this is better for their practices. So far, some of them are starting to see the benefits.”

Boston-based Atrius Health, the largest independent non-profit physician group in Massachusetts, was also selected to be a Pioneer ACO. Eugene Lindsey, CEO of Atrius Health, expects the initiative to have a big impact.

“For the groups participating in this, it will be a big leap forward,” he said. “The success we have will encourage more groups to develop these competencies in the future. The thinking behind this has been incredibly creative compared to other pilots that have been put out.”

Both Fish and Lindsey said CMS has been responsive to suggestions from the Pioneer ACOs. “We have been amazed at the sense of partnership here,” said Lindsey. “There's a real pioneer spirit behind this. It's exciting.”