Intel Corp. was one of the trailblazing employers in the direct-contracting movement, first offering its workers in New Mexico such an ACO option in 2012. Presbyterian’s Hinton says the forward-thinking company had a “bold vision” at the time: to foster the healthiest employees on the planet, and treat health care as if the advances in computing technology, rapidly growing both more powerful and less costly, also applied to health care.
Labeled as “Connected Care” and launched Jan. 1, 2013, the ACO takes a patient-centered, medical home approach to providing services, offering patients a “medical neighborhood” of specialists and facilities to receive care on demand. Presbyterian also runs an on-site clinic at the Intel campus.
Almost 60 percent, or 5,400 members, took advantage of the health plan the first year, enticed by same-day appointments and 100 percent coverage of any preventive care.
Presbyterian hit its mark that first year on quality (98 percent of enrollees expressed satisfaction) and patient experience (94 percent said they were satisfied), Hinton notes. However, the health system did miss its aggressive goals to trim costs, with medical and prescription tallies running 3.6 percent higher than expected. He attributes that to a lack of experience with the population, and the necessity of relying on historical claims data to start.
One early lesson, Hinton notes, was how important transparency is in such arrangements. If a hospital in an employer-sponsored ACO isn’t hitting targeted immunization rates, for instance, a sophisticated purchaser partner is going to know. “Just like a lot of our world, transparency changes everything,” Hinton says. “I think the progressive health systems don’t try to argue about the data. Typically, there’s general agreement as to what the performance was, and really, the time is spent figuring out how to work together to improve whatever the indicators are that are not performing well.”
The workplace clinic
Finding an employer with a concentrated mass of employees — probably around a minimum of 5,000 — is also vital to making the numbers work.
Timothy Hanson, M.D., a family physician with Presbyterian stationed at the clinic for the clinic on Intel’s manufacturing site in Rio Rancho, N.M, says relocating it where the workers are is essential to its success. He and his colleagues see patients on weekdays, from 7 a.m. to 4 p.m. for anything from managing diabetes to treating upper respiratory illness or receiving an annual physical. If they need a higher level of care, he can facilitate a “warm handoff” to Presbyterian’s urgent care clinic or to the behavioral therapist on-site. Others on the staff of 20 include a pharmacist, physical therapist and nurse care manager.
Without the clinic, Hanson believes care would be much less coordinated for Intel employees. He also believes the model has allowed him to build tighter relationships with his patients and better satisfy their needs.
“It harks back to the family doctor who knew everyone in town,” Hanson says. “From my standpoint, it’s much more satisfying than just treating a rotating population where you don’t see people and follow up. One of the reasons you go into family medicine is that continuity of care, and I think it’s a very good satisfier for the patient, as well.”
What Boeing employees get for picking the Providence-Swedish ACO
Here are a few of the perks that 30,000 or so eligible Boeing beneficiaries can receive if choosing the employer’s “preferred provider” insurance option in the Puget Sound region, according to handouts from the company:
• Same- or next-day appointments for urgent primary care visits and acute care.
• A concierge service patients can reach by phone, email or the Web
• The ability to schedule doctor’s appointments, review test results and email the care team online or through a smartphone.
• Proactive support for preventive care or managing chronic diseases.
• Shared decision-making tools to help pick the right treatment options.
• Lower paycheck contributions for some health plans.
• Increased company contributions to the health savings accounts.
• No office co-pays for seeing primary care physicians.
• Quicker access to network primary care providers and specialists, and more after-hours availability.
Making the Most of All that Data
One of the benefits for health care organizations in working more closely with employers is the trove of data gained about their workers’ use of health care services across the continuum. Boeing is self-insured and uses a third-party administrator to handle its claims.
Craig Enge, chief operating and administration officer of the Swedish-Providence Health Alliance, says Providence-Swedish has been “staffing up,” bringing in new employees with expertise in claims data analytics. UW Medicine, too, has built up its analytics department to be able to intervene quickly when a patient is in need.
Health systems that don’t add staff for data analysis are setting themselves up for failure, Enge warns. “To make these things successful, you need people who are dedicated to this work, and who wake up every day thinking about this and driving it forward,” he says. “I can’t think of how we would have done this if we didn’t take that approach.”