Becker's Spine Review

14 Leadership Here are five key notes on the group's growth: • Last year, The CORE Institute hired 41 pro- viders and 137 staff members • The group doubled the Michigan practice in the last 12 months. • The institute had a 40 percent growth for the first quarter of 2015. • The group plans to expand to Tucson, and has signed a term sheet with a state in the Southeast. • The CORE Institute signed a co-manage- ment agreement with Green Valley Hospi- tal's orthopedics department. So what's the key to the practice's success? "The reason we are able to grow so rapidly is we are scalable," says Dr. Jacofsky. "We are stan- dardized both operationally and clinically, which makes it easier to scale and oversee based on best practices and evidence-based consensus. We have a robust leadership program that includes leader- ship training for physicians." The CORE Institute University provides training and education for different staff categories to pre- vent a leadership vacuum. The most challenging part of expansion is the initial move into a new market, but once there, it's easy for the practice to implement existing platforms and increase in size. "The visibility of our outcomes and quality met- rics, and in many cases the costs for consumers and patients, is very attractive," says Dr. Jacofsky. "We are seeing increasing numbers of patients coming from outside Arizona to our facilities, and we are seeing insurance companies that have the ability to directly compare cost, quality and patient experience between different physician groups willing to create narrow networks and steer patients to the facilities they believe will pro- vide the best value." The group has a proprietary IT platform that in- cludes phone apps, customized electronic medical records, specialized pagers providers use to commu- nicate with each other, and a data warehouse to col- lect and analyze data in real time. The group invest- ed between $12 million and $15 million on their IT platforms, and has employed six to seven software engineers or programmers in-house for the past half-decade. The IT specialists are responsible for building programs and interfaces to improve value. "This concept of a virtual care network is an im- portant one," says Dr. Jacofsky. "If you are going to be at risk with payers, you need to be able to take care of the right patient with the right proce- dure in the right facility at the right time. If every total knee replacement patient were to go to the high acuity hospital or ICU, every episode of care would be expensive. One needs to triage patients between such a hospital and a specialty hospital where we treat relatively healthy patients who need inpatient care or the outpatient surgery cen- ter for young total knee patients in the best health. Direct care to the highest quality, lowest cost set- ting that provides the appropriate safety factor for that particular patient." The wealth of data allows the practice to partici- pate in bundled payment models based on the surgical episodes and 90 days after the procedure. The practice takes full capitation and full risk capitation per member per month in a manner consistent with population health. They have shared savings models through partnerships with hospitals and insurance companies. "We have programs where we receive bonus pay- ments if we reach certain rates for patient report cards," says Dr. Jacofsky. "Our biggest challenge has been managing growth and finding the right physician and hospital partners; our growth op- portunities have been so extensive that growing and executing efficiently has always been the big- gest challenge. This is why the right partner is key." In addition to the data gathering, the proprietary software programs have had an impact on out- comes, cost and patient satisfaction. In some cas- es, episodes of care were 30 percent less expensive than their competitors with a lower complication rate based on objective CMS data. Dr. Jacofsky recently started to publish articles on the use of standardized protocols to improve out- comes for arthroplasty, as well as two or three dif- ferent papers related to standardization and the use of IT platforms and integrated systems to improve outcomes and lower costs overall, says Dr. Jacofsky. Dr. Jacofsky continues to look for progressive groups looking to lead consolidation in their state and region. n Dr. David Jacofsky How The CORE Institute Grew 40% Last Quarter — IT Leads the Way (continued from cover) 1 day ASC Fusion Solution Outpatient True MIS Expandable Technology for Stand-Alone TLIF and ACDF Procedures For more information please visit: www.wenzelspine.com R Stand-Alone Expandable Solution Zero Impact Insertion Large Bone Graft Area MIS Capabilities SIGN UP TODAY Becker's Spine Review Electronic Newsletter Spine Business E-Weekly Sign up today at www.beckersspine.com

• Cover