Abstract
A fundamental question in health policy is how the newly forming Accountable Care Organizations (ACO) will achieve high quality and efficient care for patients and populations. ACO’s have been operating for about 2 years and information is beginning to be released about their performance. However, there is several years of information from an important precursor to Medicare ACO’s – the Physician Group Practice Demonstration (PGPD)2. The University of Michigan (UM) was one of 10 large physician organizations that participated in the PGPD from 2005–2010, and achieved shared savings and high quality for all 5 years. UM is an integrated academic healthcare system with experience in managed care clinical and governance integration and a unified EMR. For the PGPD, UM implemented numerous transitional care and care coordination activities. UM system characteristics and interventions were probably all important in “bending the curve”. In addition, attribution of sicker patients by attribution to the multispecialty group instead of just primary care physicians, the presence of skilled specialists and generalists who are comfortable caring for sick patients, and employed faculty physicians who are comfortable with an academic mission, may also have contributed. Future information about the performance of the many different types of healthcare systems participating in the ACO programs may very well point to many different healthcare system configurations, including Academic Healthcare Systems, which can achieve high quality and efficient patient care.
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Abbreviations
- BCBSM:
-
Blue Cross Blue Shield of Michigan
- CCMP:
-
Complex Care Management Program
- CMMI:
-
Centers for Medicaid and Medicare Innovation
- EMR:
-
Electronic Medical Record
- HCC:
-
Heirarchical Claims Categories
- M*STARR:
-
Michigan-State Action on Avoidable Rehospitalizations
- MSSP:
-
Medicare Shared Savings Program
- NCQA:
-
National Committee for Quality Assurance
- PCMH:
-
Patient Centered Medical Home
- PGPD:
-
Physician Group Practice Demonstration
- QMP:
-
Quality Management Program
- UMHS:
-
University of Michigan Healthcare System
References
Accountable Care Organizations (ACO). Centers for Medicare & Medicaid Services Website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/. Accessed 13 May 2014.
Kautter J, Pope GC, Leung M, Trisolini M, Adamache W, Smith K, Trebino D, Kaganova J, Patterson L, Berzin O, Schwartz M. Evaluation of the Medicare Physician Group Practice Demonstration final report. Research Triangle Park: RTI International; 2012.
Trisolini M, Kautter J, Pope GC, Bapat B, Olmsted E, Urato M. Physician Group Practice Demonstration quality measurement and reporting specifications. 2005. http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/Quality_Specs_Report.pdf. Accessed 13 May 2014.
Kautter J, Pope GC, Trisolini M, Grund S. Medicare Physician Group Practice Demonstration design: quality and efficiency pay-for-performance. Health Care Financ Rev. 2007;29(1):15–29.
Wilensky GR. Lessons from the Physician Group Practice Demonstration – a sobering reflection. N Engl J Med. 2011;365(18):1659–61.
Iglehart JK. Assessing an ACO prototype–Medicare’s Physician Group Practice Demonstration. N Engl J Med. 2011;364(3):198–200.
Fisher ES, McClellan MB, Bertko J, et al. Fostering accountable health care: moving forward in Medicare. Health Aff. 2009;28(2):W219–31.
Sebelius K. Report to Congress: Physician Group Practice Demonstration evaluation report. 2009. http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/PGP_RTC_Sept.pdf. Accessed 13 May 2014.
Berwick DM. Making good on ACOs’ promise – the final rule for the Medicare Shared Savings Program. N Engl J Med. 2011;365(19):1753–6.
Pope GC, Kautter J, Ellis RP, et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev. 2004;25(4):119–41.
Physician Quality Reporting System (Physician Quality Reporting or PQRS) formerly known as the Physician Quality Reporting Initiative (PQRI). Centers for Medicare & Medicaid Services Website. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/pqrs/index.html. Accessed 13 May 2014.
Colla CH, Wennberg DE, Meara E, et al. Spending differences associated with the Medicare Physician Group Practice Demonstration. JAMA J Am Med Assoc. 2012;308(10):1015–23.
Colla CH, Lewis VA, Gottlieb DJ, Fisher ES. Cancer spending and accountable care organizations: evidence from the Physician Group Practice Demonstration. Healthcare. 2013;1(3–4): 100–7.
University of Michigan Health System. http://www.med.umich.edu/. Accessed 13 May 2014.
Stiles RA, Mick SS, Wise CG. The logic of transaction cost economics in health care organization theory. Health Care Manag Rev. 2001;26(2):85–92.
Joshi DK, Bluhm RA, Malani PN, Fetyko S, Denton T, Blaum CS. The successful development of a subacute care service associated with a large academic health system. J Am Med Dir Assoc. 2012;13(6):564–7.
Williams BC, Paik JL, Haley LL, Grammatico GM. Centralized care management support for “high utilizers” in primary care practices at an academic medical center. Care Manag J. 2014; 15(1):26–33.
Project BOOST: better outcomes by optimizing safe transitions. Society of Hospital Medicine Website. 2014. http://www.hospitalmedicine.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=27659. Accessed 13 May 2014.
Joint Principles of the Patient-Centered Medical Home. Patient-Centered Primary Care Collaborative website. 2007. http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf. Accessed 13 May 2014.
Patient-Centered Medical Home Recognition. National Committee for Quality Assurance (NCQA). 2014. http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx. Accessed 13 May 2013.
Fisher ES. Building a medical neighborhood for the medical home. N Engl J Med. 2008; 359(12):1202–5.
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Blaum, C.S., Williams, B.C., Spahlinger, D.A. (2015). University of Michigan Case Study: The Physician Group Practice Demonstration. In: Powers, J. (eds) Healthcare Changes and the Affordable Care Act. Springer, Cham. https://doi.org/10.1007/978-3-319-09510-3_12
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