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Brandeis University

A View Into Accountable Care

Risk Contracting and Operating Practices in 21 Organized Delivery Systems

Robert MechanicSenior Fellow

Brandeis University

Third National ACO CongressOctober 31, 2012

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Research Questions

• How much risk contracting is really out there?

• How have medical groups prepared for payment reform?

• What do medical groups see as the largest hurdles?

The Study:Survey and interviews of 21 large medical groups

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Surveyed Groups (Fall 2011)

Atrius Health

Group Health Physicians 

Mayo Clinic

Austin Regional Clinic

Health Care Partners 

Oschner Health System

Billings Clinic

HealthPartners Medical Group

Palo Alto Medical Foundation

Dean Health System

Henry Ford Medical Group 

Scott & White Healthcare

The Everett Clinic

Intermountain Medical Group 

Sharp Rees‐Stealy Med Group

Fallon Clinic 

Kaiser Permanente Med Group

Virginia Mason Medical Group

Geisinger Health System 

Marshfield Clinic 

Wenatchee Valley Med Center

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Number of FTE Physicians by Type

Note: Excludes the Permanente Medical Group.

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Facility and Health Plan Ownership

Source: Self-reported survey data from 21 CAPP medical groups.

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Payment Profile

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Type of contract as a percent of total patient revenue

Note: Calculated as a simple (unweighted) average (n= 21).

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2010 Patient Revenue by Contract Type

Source: Self-reported survey data from 21 CAPP medical groups.

FFS-based Risk-based

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Operating Characteristics

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2010 PCP Compensation Method

Source: Self-reported survey data from 21 CAPP medical groups.

FFS-based Risk-based

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Group Payment vs. MD Compensation

Page 12

Dean Clinic transition toward a value- based compensation plan (specialty)

FFS/VolumeBased

ValueBased Source: Craig Sammit,,MD

One example:

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98%

2%

95%

60%

20%

15%

10%10%

40%

20%

20%

15%

10%10%

0%

20%

40%

60%

80%

100%

2009 2010Option A

2010Option B

Future?

Dean PCMH Compensation Model Transition

Efficiency

Quality

Service

Panel Size

RVUs - 5%

RVUs

Salary

95% 115% 115%100%

Dean Clinic Realignment of Primary Care Compensation

Source: Craig Sammit,,MD

One example (continued)

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System Assets by Type of Group

Source: Self-reported survey data from 21 CAPP medical groups.

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Data Management Capacity

Source: Author’s analysis of self-reported survey data from 21 CAPP medical groups.

Percent of Groups Reporting “Fully Implemented”

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Performance Improvement Initiatives

Source: Author’s analysis of self-reported survey data from 21 CAPP medical groups.

Percent of Groups Reporting They are “Far Along”

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Attitude toward expanding future risk contracting (n=15)• All expect expanded risk contracting• 11 groups seeking new risk contracts• 3 were preparing for payment

system change• 1 group not interested

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What are the largest challenges to increasing your revenue from alternative payment contracts? (N=14)

Source: Author’s analysis of self-reported survey data from 21 CAPP medical groups.

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Conclusions and Issues• “Many large medical groups will need

to acquire new skills and tools to be ready for payment reform”, Health Affairs Sept 2012

• Significant challenges and cost to implement these changes broadly

• Sources of capital for infrastructure?– Insurers?– Hospitals?– Government?

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Hospital-Physician Alignment

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Provider-Insurer Alignment

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Expert Perspectives

Jay Crosson, MDVice President of Professional Satisfaction

– Care Delivery and PaymentAmerican Medical Association

Don Rebhun, MDRegional Medical DirectorHealthcare Partners

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Thank You

Robert MechanicSenior Fellow

Heller School for Social Policy & Mgmt.Brandeis University

mechanic@brandeis.eduhttp:/healthforum.brandeis.edu