Baylor Scott & White Quality Alliance, a wholly controlled affiliate of Baylor Scott & White Health, is a clinically integrated ACO with a physician-led board of managers. The board of Baylor Health Care System (BHCS) formed the ACO in April 2011 as a limited liability corporation with physicians as participation members rather than owners. Physicians pay an initial fee of $1,500 to join the ACO.
When the BHCS board initially formed the ACO, then known as Baylor Quality Alliance (BQA), it believed the organization would be unable to meet the federal government’s preliminary rules for ACO formation, so it structured BQA to achieve accountable care goals (i.e., delivering high-quality care while lowering overall costs) without the intent of pursuing formal ACO status through the Medicare Shared Savings Program. When the final federal regulations were released six months later, however, leadership at BHCS and BQA reconsidered, deeming the rules manageable and believing that BQA was capable of accomplishing shared savings through the MSSP.
BSWQA is structured based on a patient-centered medical home model (whereby a medical home physician coordinates care across all settings). Participating physicians must submit quality and cost data, implement an electronic health record system and use evidence-based care paths and protocols established by Baylor.
Much of the ACO’s focus to date has been on building the IT infrastructure necessary to enable its many participating physicians to share patient information, a key factor in coordinating care. The 600-plus physicians in BHCS’s employed physician group (the HealthTexas Provider Network) was already using a shared EHR system, but participating independent physicians are using more than 40 different EHR systems, making communication among the many providers a serious challenge. To address this issue, the organization partnered with Sandlot Solutions in August 2013 to develop an innovative, patient-centric, “community” health information exchange (HIE) that allows sharing between private HIEs.
BSWQA also has invested in various clinical IT solutions—including technology by Humedica (now owned by UnitedHealth Group’s health services platform, Optum Inc.), 360Fresh (now part of The Advisory Board Company) and Explorys—for analytics designed to make patient data more actionable through population segmentation, risk analysis and predictive modeling, along with other capabilities. For example, the analytics solutions can identify gaps in care and target patients with chronic diseases who receive services in the acute care setting so that a care team can be deployed to manage the patients’ health and potentially prevent unnecessary readmissions for the same illness). In addition, the Humedica technology makes it possible to combine cost and quality information in the same data tool.
“In healthcare IT, we're not currently agile enough to support the pace of changes we're seeing in our business model and industry,” said Matthew Chambers, Baylor Scott & White CIO, in a recent interview with Becker’s Hospital Review. “Meanwhile, we're still in the tail-end of very large operations systems implementations with our EHRs, and we're not yet nimble enough to meet the need of our business right away. We're therefore trying to retool on the fly.”
Other major efforts BSWQA has undertaken include initiatives focused on clinical standards and best care practices, as well as an increased emphasis on care coordination from a staffing perspective. For instance, the organization has RN health coaches who educate patients and assist them in learning how to self-manage their health, where practical—particularly for high-risk patients and those with multiple illnesses. These RN health coaches also facilitate continuity of care during the transition phase when patients are discharged following a hospital stay. The ACO also has health coordinators who monitor emergency department and inpatient transitions and are responsible for completing protocol-driven patient outreach to close gaps in care for preventive services.
Recent Baylor Scott & White Health or BSWQA partnerships include:
Aetna and BSWQA have a commercial ACO collaboration under the Aetna Whole Health brand. It began in late 2014.
In February, BSWQA and Tenet’s ACO created a value-based care partnership involving four hospitals, six outpatient centers and more than 170 physicians.
In late March, Baylor Scott & White Health and Tenet Healthcare completed a definitive partnership agreement including five Texas hospitals: Dallas-based Doctors Hospital at White Rock Lake, Centennial Medical Center (Frisco), Lake Pointe Medical Center (Rowlett), Texas Regional Medical Center (Sunnyvale) and Baylor Medical Center (Garland). The companies will jointly own the hospitals, with Baylor Scott & White holding a majority. The hospitals will use the Baylor Scott & White brand but will continue to be operated under its current leadership.
Also in March, BSWQA entered into an agreement with UnitedHealthcare for 52,000 UnitedHealthcare members in North Texas, with employer-sponsored health plans.
BSWQA has earned Level 2 accreditation from the National Committee for Quality Assurance. NCQA has three accreditation levels based on patient access to care, patient rights and responsibilities, patient-centered primary care, care management and coordination, program operations, performance reporting and the ability to collect data and integrate it with care delivery.
In October 2013, BHCS and Temple, Texas-based Scott & White Healthcare completed a merger, creating the state’s largest not-for-profit health system with 43 hospitals, more than 500 clinics and other care sites, 6,000 affiliated physicians and 34,000 employees.