A Healthy Growth Pattern- Accountable Care Associates Continues to Expand Its Reach

As Dr. Phillip Gaziano and his partners were incorporating the company they would call Accountable Care Associates in 2010, the consultants hired to advise them on the venture told them they should be ready for what would likely be rapid and profound growth.

As things turned out, they might actually have been understating the growth potential of this management-services organization, a spinoff of Hampden County Physicians Associates (HCPA) that markets itself as “national pioneers and leaders in managed-care tools and services.”

“We and they [the consultants] were looking at the changes taking place in healthcare delivery and saying, ‘this might be just the right recipe,’” said Gaziano, referring to the company’s suite of products and services, and adding that those words have certainly proven to be prophetic.

Indeed, in late 2010, ACA, as it’s called, counted 120 primary-care physicians (PCPs) as clients, and 17,000 members (patients) being managed by its systems. By January of this year, ACA networks, which are set up for global capitation programs, have grown to include roughly 2,000 PCPs and 20,000 physicians, and about 100,000 members. The company also boasts 20 partner hospitals and medical systems, including Mercy Medical Center, and is now doing business in 10 states, with more territorial expansion planned for this year.

ACA, which moved its main operations center from Birnie Avenue in Springfield to the 10th floor of downtown Monarch Place roughly a month ago, is effectively doubling its size every four to six months, said Gaziano, who told HCN that such growth is certainly no accident.

Instead, it’s a function of having the right mix of products and services — specifically an IT infrastructure and a comprehensive support system behind it — at the right time, when the healthcare system is moving from the traditional fee-for-service delivery and payment model to what’s known as an accountable-care organization model, which Gaziano describes with the broad phrase ‘population management.’

This is not necessarily a new term in healthcare, but until very recently, it was used by, and in reference to, those in the insurance side of this sector. Now, it is increasingly being used by providers, he explained.

“Under these new systems of care delivery and payment delivery, the management functions are shifting to the providers,” he told HCN, adding that these providers generally can’t manage this shift by themselves. “They need a support system, and we became one of the best in the country at providing that support.”

Gaziano described ACA as a “Swiss Army knife” type of service provider, offering everything from management support to technology and data; care management to provider education and training.

On the data side, the company’s products facilitate collection, sharing, and analysis of relevant information, he explained, which enables providers to tailor high-quality care programs more effectively. ACA’s data warehouse, for example, offers a comprehensive view of each patient’s medical history, he went on, offering providers real-time access to the details of when, where, and why patients receive care. This information is used to generate regular reports on patient care, allowing those providers to identify areas of improvement.

ACA, which now employs more than 140 people in three offices (the others are in Auburn, Mass. and Connecticut) and is in what Gaziano describes as a “nearly constant” hiring mode, is one of several business success stories unfolding in downtown Springfield. It is also a venture on the cutting edge of change in healthcare, enabling providers to reduce costs, improve quality of care, and help improve the overall health and well-being of communities.

 And for this issue, HCN takes an indepth look at why those consultants were predicting such profound growth for ACA, how it came about, and also how the company was not only ready for it, but is primed for much more.

The home page on ACA’s website includes imagery showing light coming from the end of a tunnel.

It’s a simple yet powerful way of communicating what the company provides for its many different kinds of clients — help with finding that light, said Gaziano, adding quickly that the changes now taking place within the healthcare sector, while obvious and irreversible, are nonetheless confusing to some and daunting to many.

In the simplist of terms, ACA is a support system created to help providers navigate these changes and, while doing so, implement methods to improve outcomes in the most efficient ways possible, said Gaziano, adding that ACA is essentially taking the success first enjoyed by HCPA to a much larger stage.

Tracing that history, Gaziano started with his own career shift, from work as an internist, geriatrician, and teacher into population management in the mid-90s.

“At that time, the first Medicare Advantage [managed Medicare] contracts were coming out here from the Boston area,” he explained. “They had started in L.A. in the late ’80s, moved up and down the East Coast and then to Boston by the early ’90s, and then worked their way out to Springfield.

“I applied my geriatric and internal-medicine training to managing 1,000 seniors in the valley,” he went on, adding that HCPA started to record solid outcomes, meaning improved quality and reduced cost to Medicare, and eventually achieved national best-practice ratings. And when the other six physician groups in the county decided to try and follow suit, but couldn’t because they didn’t have the IT infrastructure, they came under HCPA management, growing the network from 1,000 members to 5,000.

For a decade that network served seniors, but in 2005, the membership base broadened significantly when Blue Cross Blue Shield approached HCPA about entering into a global payment contract.

“Blue Cross came to us and said, ‘we’d like to start this alternative quality contract,’ which is a globally managed commercial plan for young people,” Gaziano explained. “They said, ‘we know you’re among the best in the country with outcomes regarding quality and cost-saving outcomes for Medicare, but can you do it commercially as well?’ And I said, ‘I think we can.’”

  Success with that contract eventually led to requests for support systems for groups outside the Pioneer Valley, first in Central Mass. and more of New England, and eventually to other parts of the country. With territorial expansion came a broadening of services, beyond Medicare Advantage and alternative quality contracts, to also include a growing number of accountable-care organizations (ACOs) as done for Medicare.

ACOs are essentially groups of caregivers — doctors, nurses, specialists, therapists, case managers, nutritionists, and assorted others — who collectively take on patients for a set fee. The model is intended to curb unnecessary tests and procedures, saving money, but with patient safeguards built in — if they don’t achieve healthy outcomes, no one gets paid.

It’s a challenging new paradigm, and ACA is setting up these organizations in 10 states, with more to follow, and, in the process, is expected to add 1,000 to 3,000 new PCPs by the end of July. It is now managing more than 100,000 members, half of whom are Medicare, and the other half families.

The company’s success can be traced back to that notion of being in the right place at the right time, and with the right mix of products and services, said Gaziano, adding that this means both clinical-support systems and tools — such as case management, disease management, training of the medical director and the hospitalist, among others — as well as data tools, which can assist PCPs even if they’re still using paper charts or simple forms of electronic medical records (EMR) and are not integrated with anyone else.

“Our data tools give them web access to manage an entire population that they couldn’t otherwise,” he explained. “Because we have a combination of clinical and data support, we’ve never had a group, no matter how big or small, not be successful in population management.”

Physician groups don’t have to be large to become part of an ACA network, or have an extensive EMR system in place, or even any managed-care experience, said Gaziano, adding that the only real prerequisites are an open mind and a willingness to trust a company with a proven track record.

“What we need are physicians — and it could be a sole practitioner or a 1,000-member group — to be willing to take a chance and turn our tools on,” he noted. “If they’re willing to try and let us work together, then we can bring these new groups of providers into this new age of population management, with better outcomes, better satisfaction of the members we serve, and better satisfaction among physicians and their office staff, because the system rewards them and pays them for some of that management function.”

Looking ahead, Gaziano said that ACA, because it was prepared for the strong growth curve that has ensued, is well-positioned to continue its current rate of expansion.

The company is currently operating in Massachusetts, Connecticut, New York, New Jersey, Pennsylvania, Illinois, West Virginia, Ohio, Iowa, and California, he said, and is eyeing opportunities in other states. Meanwhile, the company will physically expand, he said, adding that plans are being developed to open an office on the West Coast.

The only real barrier to growth is a lack of knowledge about what the company does and how it can help a provider, regardless of size, he noted, adding that building such awareness is one of the priorities moving forward.

“What holds providers back is a lack of knowledge of how it works, and fear that the system may change again,” he explained, adding that ACA has a firm grip on what may change down the road.

And it can also provide a path to that light at the end of the tunnel, which is perhaps the best, and simplest, way to sum up this burgeoning success story.