Many Roles for PAs in an ACO Healthcare Model

While accountable care organizations (ACOs) are discussed in only seven pages of the massive Affordable Care Act (ACA), they have gotten plenty of attention over the past year.

In a nutshell, an ACO is a network of doctors and hospitals that shares responsibility for providing care to patients and manages all of the healthcare needs for a minimum of 5,000 Medicare beneficiaries for at least three years. ACOs would make these networks of healthcare providers and institutions jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures.

In addition to traditional fee-for-service, ACOs would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers would get paid more for keeping their patients healthy and out of the hospital.

This is a novel concept in the US healthcare system and creates the potential for better reimbursement, but also introduces risk and potential loss of revenue.

For a better understanding of the risks and rewards, I turned to my colleague Beth Grivett, PA-C, who works in a newly-formed administrative role at an Independent Physician Association in south Orange County, Calif., that employs hundreds of physicians, PAs and nurse practitioners.

Every day, she focuses on helping providers of the IPA transition to an ACO model of care and getting traditional clinicians to transform their thinking from a “fee-for-service” to one that values preventive metrics.

She believes that improving practice performance in the area of prevention is also better for the community as it increases the health of population, in addition to being cost effective and increasing reimbursement in the new paradigm of health reform.

Patients, like healthcare providers, don’t have a lot of experience in this area. One of the challenges early on is changing the thinking of the patient, and changing their mindset to what they can do to stay healthy - rather than seek treatment for ailments. The patient needs to be incentivized to think differently because there is no copay for many preventive services to incentivize patient care.

Resistance from providers is not a problem once they understand that focusing on prevention and quality care measures as it increases reimbursement.

Beth is at an administrative level, yet many PAs do very well in this ACO care delivery model because of their unique relationship with physicians, staff, and patients and coordination of care responsibilities. PAs are also acculturated to explain things well to patients and take the time to educate them. Although there have been challenges along the road, Beth feels that her organization has done a good job transitioning to a new model of healthcare delivery because the organization consciously values every member of the healthcare delivery team, not just the physicians. Every member of the practice team has a stake and role in the change process.

Like modern healthcare, every member of the healthcare team has a specific role and responsibility to keep patients healthy. In the ACO model, PAs, advanced practice nurses, and other non-physicians focus more on preventive visits, which frees physicians to on focus on more complex problems.

Beth has worked in her administrative role within the ACO to set up chronic care management delivery modules to better focus on clinics in hypertension, diabetes, COPD, etc. People getting better means cost savings and more profit. However, you have to be able to measure outcomes objectively. That is why working with information technology staff on data collection strategies to support objective measures of outcomes is so important.

PAs are excellent for these sorts of administrative roles because of their training in general medicine, health education, and their acculturation early in their careers for team-based practice.

We need to do more to educate physicians, PAs, and others providers about the healthcare reform law and its provisions for incentivizing preventive care.

Find out more about Stephen Hanson and our other Practice Notes bloggers.This blog was provided in partnership with the American Academy of Physician Assistants.