AAFP study sees success in clinic-based ACO

An accountable care organization in Texas is providing healthcare services that improve patient care and outcomes through a network of patient-centered medical home clinics instead of a hospital, according to a  case study from the American Academy of Family Physicians.

The AAFP's "Case Study of a Primary Care-Based Accountable Care System Approach to Medical Home Transformation," by Robert Phillips, Jr., MD, director of the Robert Graham Center for Policy Studies, was published this week in the Journal of Ambulatory Care Management.

"This shows that primary care physicians can organize to develop their own accountable care system," said Phillips of the study. Small and solo physicians can participate in ACOs, he said, by affiliating with one another under an organizational structure that incorporates ACO functions.

"Being part of an organization in some form is needed to get this level of care," he said.

Over the past 20 years, the WellMed Medical Group in San Antonio has developed a care model that meets 97 of the 100 elements that define a patient-centered medical home, according to the National Committee for Quality Assurance guidelines.

The study looked at the organization and services provided between 2000 and 2008 by WellMed, which has more than 87,000 patients and plan members. Researchers focused on Medicare Advantage patients, many of whom have complex health conditions such as diabetes, congestive heart failure, ischemic heart disease, chronic obstructive pulmonary disease and asthma, who were receiving care at 21 WellMed Group practices in San Antonio.

Each of WellMed's patients has a primary care physician who provides diagnosis, treatment, referrals to sub-specialists and coordination of all care. Each physician cares for fewer than 500 patients on average, and works with nurse practitioners, physician assistants, health coaches and social services workers. The clinic provides an on-site pharmacy, dental and vision services, hearing aid benefits, nutrition counseling and transportation assistance.

An electronic data monitoring system helps to track and analyze each patient's experience. Patients are given a portable device that provides secure online access to their medical records, which ensures that sub-specialist physicians and hospital, nursing home or home care agency staff have the most current information about their patients.

During the case study, Phillips and his colleagues found that although the clinics cared for older patients and more men than is typical for Medicare, "WellMed improved preventive care for the conditions that we measured and achieved remarkably high guideline compliance for diabetes and blood pressure. Their mortality rates remain well below the state average."

The case study demonstrates that a primary care physician-based ACO is not only viable, but also effective in providing high quality and efficient care, according to Phillips.

"You can get much better outcomes" with such a PCMH-based ACO over the current health delivery system, he said. "Their preventive measures are better and the mortality was half that for people of the same gender and age" statewide in Texas.