Denver Health Care Company Transitions from Pioneer ACO Model

Physician Health Partners, one of 32 Pioneer Accountable Care Organizations in the US, plans move to the CMS Medicare Shared Savings Program.

Denver, CO, July 17, 2013 --( Physician Health Partners (PHP), a medical management company, along with its three strategic partner independent practice associations, announced today that it is leaving the Pioneer Accountable Care Organization (ACO) model to pursue participation in the Centers for Medicare and Medicaid Services’ (CMS) Medicare Shared Savings Program (MSSP).

In 2012, PHP and its affiliated 230 primary care physicians was selected as one of 32 “Pioneers” by the Center for Medicare and Medicaid Innovation (CMS Innovation Center) to serve nearly 25,000 Medicare beneficiaries in the Denver metro area with enhanced health care services and coordinated care.

Physician Health Partners remains committed to the ACO philosophy to improve care outcomes for their aligned patients while working to contain the associated costs and stands committed to continuing their work with the CMS to enhance the Medicare experience for Coloradoans.

“At the end of the day, our goal is to improve the care for our patients and we are obligated to do everything we can to make that happen,” Steve Krebs, MD, Physician Health Partners’ Chief Medical Officer said. “We believe in the ACO model and are on board to continue down that path with CMS. It just won’t look exactly like the Pioneer ACO model.”

PHP has found the Pioneer ACO financial risk structure restraining due to a few factors such as geographic considerations, data capabilities and timelines, and the risk carried for patients who see unaligned physicians. The PHP goal is to smoothly transition from the Pioneer ACO to the MSSP to ensure there is not a lag in expanded care services or data for their aligned patients. The MSSP is a different Medicare ACO program through CMS that bears less financial risk for the health care entity while still offering more services to patients.

“We are confident we can help improve health outcomes and costs in the Medicare population and are committed to working with CMS to make sure we’re able to continue our work with improving the Medicare system,” Kenneth Nielsen, Physician Health Partners’ President and CEO said. “The Physician Health Partners-affiliated primary care providers serve more than 400,000 patients in the 7-county Denver metro area and our goal is to ensure we are giving these folks the best care we can.”

Physician Health Partners and the partnering IPAs (Primary Physician Partners and South Metro Primary Care) collaborate to improve patient care, while lowering the associated costs. Their primary care physician model focuses on creating medical homes, providing patients with additional care resources, and managing the care of their patients throughout various healthcare settings. PHP began as a Pioneer ACO in January 2012 and was chosen specifically by the CMS Innovation Center to test the effectiveness of several models of payment and assist healthcare providers in making a rapid transition to higher quality care at a lower cost to Medicare.

Additional Information from CMS Announced Today:

About CMS and ACOs:
The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doctors and other healthcare providers who work together to provide high quality care for their patients. Under the Pioneer ACO Model, CMS will provide incentives for participating healthcare providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.

Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. The Pioneer ACO Model is not a health plan or managed care plan. Under the Pioneer ACO Model, beneficiaries seeing doctors participating in an ACO will maintain the ability to see any doctor or healthcare provider, as well as the full benefits associated with traditional Medicare.

The Pioneer ACO Model is one of a number of initiatives developed by the new Innovation Center. The Innovation Center was created by the Affordable Care Act to test new models of healthcare delivery and payment.

About Physician Health Partners:
Physician Health Partners (PHP) is an integrated team of physicians and healthcare professionals committed to supporting effective patient care throughout the healthcare continuum. Founded in 1996 as a management services organization, PHP believes physicians and other providers have the capability and responsibility to drive high quality, cost-effective healthcare for patients. Through our robust Clinical Quality Improvement Services and diverse medical management solutions, PHP works to support primary care physicians in improving clinical outcomes for the benefit of the patient. By improving clinical outcomes, enhancing provider performance and developing practice efficiencies, patients' health status is improved and overall healthcare costs are reduced.

Physician Health Partners collaborates with more than 300 primary care providers, both physicians and mid-level providers, in the Denver metro area and approximately 600 specialists who share a goal of providing the right care, at the right time, and in the right setting to improve the quality of care and lower the costs associated.
Physician Health Partners
Abby Brookover