Becker's Hospital Review

49 Physician Affairs I n late January, a powerhouse of the biggest health systems in the country pledged to shift 75 percent of their business to value-based payment arrangements by 2020. Health systems are one type of organization in- volved in this 28-member new task force — the group also includes payers such as Aetna, Blue Cross Blue Shield of Massachusetts and Blue Shield of California, along with policy groups like Dartmouth Institute for Health Policy and Clini- cal Practice and Leavitt Partners. Downers Grove, Ill.-based Advocate Health Care is one of the provider organizations to join the task force. Lee Sacks, MD, executive vice president and CMO of Advocate Health Care, says the timing of the announcement — made the same week HHS an- nounced goals to move Medicare more toward value- based reimbursement — was coincidental. The task force has been in the works for a while now. Dr. Sacks attended the first meeting about it in June 2014. "It's been a lot of work, and the thinking was we needed something fairly tangible and concrete be- fore making a public announcement," he says. "I said this to a colleague a couple of hours ago: 'Did CMS get wind of this?' But, you know, it's all for the same cause." Payers and providers in the task force have pledged to shift 75 percent of their businesses to value- based payment arrangements by 2020. (One of HHS' new goals is to shift half of its Medicare pro- vider payments to value-based models by 2018.) Dr. Sacks says the task force's timeline will set or- ganizations on a "path that won't put them out of business." It's very doable, he says. This is especially true for Advocate. The health sys- tem is poised to reach the task force's goal — 75 percent of business from performance-based reim- bursement — by the end of this year. Already, in 2014, approximately 63 percent of payments to Ad- vocate providers came in via value-based contracts. This was before Advocate launched its Medic- aid accountable care entity, a three-year perfor- mance-based agreement under Illinois' Medic- aid program. Advocate was one of the first five healthcare organizations in the Chicago area to receive the state's approval to launch the ACE. With that addition, Dr. Sacks expects 75 percent of the health system's business to be value-based by the end of 2015. "We're almost there," he says. "We've been on this journey — this is our fifth year of working with com- mercial payers and shared savings [agreements]." Advocate has positioned itself as a leader in popu- lation health management, striking one of the earliest and largest accountable care organizations with Blue Cross Blue Shield in 2010 and remov- ing costs from the system through chronic disease management. The system also has an ACO in the Medicare Shared Savings Program, which hasn't stirred as much enthusiasm. "I think it's not a big secret that a lot of delivery systems have been disappointed with the MSSP, whether it is the potential for savings, data lags or a lack of patient engagement," says Dr. Sacks. "It became clear for things that were frustrating us on the delivery system side, that unless we had a coalition that included payers, purchasers and delivery systems, we really weren't going to be able to solve the problem. It's about sitting down and saying, 'We all think the world needs to move to value, but how do we create a move to value that works for everybody?'" n T he Texas Medical Association and Blue Cross Blue Shield of Texas struck an interesting agreement in early February to form a new or- ganization — called TMA PracticeEdge — that will help indepen- dent physicians secure value-based contracts. Bert Marshall, president of Blue Cross and Blue Shield of Texas, expects the ACO-enabling organization — as he describes it — to be "up and running" in just a few months. Autonomy is something Texas physicians take seriously — approximately two-thirds of physicians in the state practice independently. TMA is the larg- est medical association in the country, with approximately 48,000 physician and medical school members. TMA PracticeEdge will act as a stepping stone and resource for independent physicians who want to move toward performance-based reimbursement, but are not interested in hospital employment. The organization will offer consultations to reduce the burden of data entry, for instance. It will also assist physicians with care coordination to better manage high-risk patients and provide software tools for population health management. The organizations say TMA PracticeEdge will help connect physicians based on the needs of their specific patients rather than which system employs them. "What we're working with TMA around is providing options for those physi- cians to be able to access value-based care contracts. When this is fully imple- mented, they will have access to those contracts and the option to remain independent," says Mr. Marshall. "Really there is a barrier to independent physicians being able to do this without this type of organization." BCBSTX serves more than 5 million members. n Why Advocate Joined the '75% by 2020' Task Force By Molly Gamble The New 'ACO-Enabling Organization' in Texas By Molly Gamble SAVE THE DATE! Becker's Hospital Review Annual Meeting May 7-9, 2015 Swissôtel - Chicago, Illinois 153 Great Health System Executives Speaking 119 Sessions - 212 Speakers To learn more visit www.BeckersHospitalReview.com To register, visit www.regonline.com/hospitalreview6thannualmeeting

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