Our client’s need
A five hospital health system developed a physician-led, clinically integrated accountable care organization (ACO) consisting of academic medical school physicians, health system employed physicians, and selected specialty physician practices in the health system’s service area. The ACO provided a vehicle for improving the quality of care, managing costs, improving outcomes, and thereby increasing patient satisfaction. Having created an effective, integrated, and accountable healthcare delivery structure (i.e., the ACO), the health system wanted to include community-based providers, such as physicians into the continuum of care, to offer community-based providers a means to participate in new value-based programs preparing them for the future of healthcare delivery, and to maintain and expand their (the health system’s) market share.
Baker Tilly’s solution
Baker Tilly helped form an independent practice association (IPA) for the health system using data analytics to identify the system’s community-based providers. Health plans that eventually contracted with the IPA provided additional data for provider recruitment and opportunities for improved reimbursement. The IPA was developed to be a vehicle for the recruited providers to be educated in and move closer to becoming part of value-based programs and for the IPA to have access to provider data to review provider performance and results and outcomes. The health system believed that achieving the goals of the IPA would create a bridge for other providers to become part of the ACO.
All parties were able to benefit from the IPA. Health plans collaborated with the health system by allowing the use of their utilization data to identify key providers along the continuum of care, and the IPA successfully contracted with the major health plans in their service area. This engagement was a great example of the new paradigm of healthcare where a provider, community-based providers, and a health plan can work together to see benefits:
- The health system secured the loyalty of community-based providers within its service area
- Community-based providers were provided access to an infrastructure for participation in value-based arrangements with health plans, education in best practices, preparation for the evolution from fee-for-service medicine to value-based payments, and inclusion in the future of the healthcare delivery system
- Health plans secured collaborative relationships with providers, achieved cost savings, and aligned their goals for population health management with participating providers
- Health plan members benefited through quality of care, improved outcomes, and patient satisfaction
For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.