As San Francisco-based Catholic Healthcare West executed a governance restructuring strategy during the latter part of 2011 and into 2012 to position the not-for-profit organization for growth, the health system—the fifth largest in the nation—changed its name to Dignity Health and underwent a simultaneous change in corporate identity. As part of this broader corporate restructuring, it initiated a clinical integration strategy and began investigating the possibility of applying for participation in the Medicare Shared Savings Program.
Dignity Health entered into discussions with several Arizona hospital systems regarding the possibility of jointly developing an ACO, eventually teaming up with Vanguard Health Systems, which then owned Arizona-based Abrazo Health Care. Together, Dignity and Vanguard created a physician-led and physician-governed clinically integrated organization called Arizona Care Network (ACN) to serve residents in Maricopa County.
Tenet Healthcare Corp. purchased Vanguard (and Abrazo) in 2013, and in January 2014, Tenet and Dignity Health completed a joint venture arrangement in which each assumed a 50 percent ownership in ACN.
During its first year of operation, ACN focused on developing the infrastructure necessary to support its participation in the Medicare program, primarily working on implementing quality reporting processes, establishing data feeds for claims data from Medicare and employing a mix of care management professionals to serve patients with complex and chronic care needs.
The ultimate goal, according to previous interview with Todd Ricotta, ACN’s executive director, is to create a common ACN identity and patient experience among all of the participating physician practices—whether solo practices or large physician groups—while permitting the physicians to stay in their respective practices and maintain their independence, if that’s their long-term objective.
As ACN’s infrastructure has evolved, the organization has also focused on growing its provider network. As of mid-2014, the number of physicians in the network had doubled, with more than 2,400 physicians, 12 acute care/specialty hospitals, Phoenix Children’s Hospital, over 100 other health care facilities—including urgent care clinics, imaging centers and skilled nursing and hospice facilities—and more than half of all recognized patient-centered medical home models in Arizona.
The organization has also turned its attention
toward developing contractual arrangements for shared savings with commercial health plans and directly with employers.
To facilitate clinical collaboration among the network’s many providers, ACN offers OnePass secure (encrypted) messaging via mobile device and desktop platforms at no cost. ACN is also in the process of rolling out a health information exchange that is available to all participating providers. Ricotta said the adoption rate has been high—an estimated 75 percent of the network’s providers subscribe and have access to the HIE, but the scope of services available through the HIE is still limited.
The organization’s care management program includes ambulatory care teams—which consist of a nurse care coordinator, a social worker, community resource aides and a clinical pharmacist—and post acute care teams, which consist of a nurse care coordinator and a community resource aide. The case managers have developed strong enough relationships with the network’s providers that they’ve begun to imbed themselves in the physician practices, making it easier for patients to access care coordination and easier for providers to make referrals.
By the Numbers
Initially, ACN had approximately 1,200 participating primary care and specialist physicians. Based on that criterion, the organization was assigned 25,000 Medicare beneficiaries through the MSSP. Today, it covers more than 27,000 Medicare beneficiaries, compared with 11,500 in the Scottsdale Lincoln (now HonorHealth) MSSP, 10,000 Priority Care Plus Medicare beneficiaries and 50,000 Medicare beneficiaries in the Banner Health Pioneer ACO.
The ACN network currently cares for approximately 120,000 lives. About a quarter are Medicare fee-for-service patients; the remainder are individuals enrolled in Medicare Advantage, commercial ACO agreements with Aetna and United Healthcare, or self-insured employer plans, including Dignity Health’s self-funded employee plan.
ACN is one of the larger MSSP ACOs; it is ranked in the top decile by number of beneficiaries. Compared with other MSSPs, ACN is about average in reported quality metrics for diabetes, coronary artery disease, hospital readmissions and health status. For the first performance year, ACN fell short of its projected spend by about $9.6 million.