What is an ACO?

In this new world of health care, physicians will earn bonuses based on whether they can keep their patients healthy — a value-based payment system.
 

The Affordable Care Act established Accountable Care Organizations (ACOs) as voluntary groups of physicians, hospitals and other healthcare professionals who accept responsibility for the overall quality, cost and care of a defined group of beneficiaries. When the insurers/payers (commercial and government) save money on services because a patient population is healthy, they split the savings with the ACOs in which they participate.


ACOs in North Texas


For the second year in a row, the Dallas County Medical Society Socioeconomics and Healthcare Transformation Committee compiled data from North Texas Accountable Care Organizations (ACOs) to provide a tool to help the DCMS membership understand the ACO players in the marketplace. 
 
For practices considering joining an ACO, one of the biggest challenges is gaining an understanding of the similarities or differences between the organizations. Another challenge is understanding how participation in a coordinated care setting may affect your practice’s bottom line. The survey developed by DCMS can hopefully answer some of these questions for your practice.
 
A questionnaire was sent to all of the known ACOs for the region. The responses in the grids represent voluntary responses sent in by the participating ACOs.  The information contained in this survey is for general informational purposes only. The data is subject to change at any time. The information is current as of the 11/22/2016. We encourage you to contact each ACO if you would like detailed information not provided in the survey. For more information regarding survey methodology, email Anna Acuña.

VIEW THE 2017 ACO GRID

DCMS would like to thank the participating organizations for their time and efforts in providing a more robust picture of the requirements for physicians interested in coordinated care.

 Baylor Scott and White Quality Alliance  Methodist Alliance for Patients and Physicians  Premier Patient Healthcare 
 Catalyst Health Network  North Texas CIN, Inc.  Southwestern Health Resources Physician Network
 Children’s Health Pediatric Alliance  Physicians ACO, LLC  USMD Physician Services






 
Baylor Scott and White Quality Alliance (BSWQA) strives to execute on the three key strategies deemed essential to care management and ultimately clinical integration. 

Medical Home: Patients in a BSWQA PCMH are paired with a dedicated primary care physician who utilizes an EHR system, evidence-based protocols, and care teams to manage the health of patient populations through preventive health services and chronic disease management. 

Care Coordination: BSWQA’s established comprehensive care management department is comprised of registered nurse care managers, licensed social workers, and health coordinators who assist patients with emergency department and in-patient/post-discharge transitions, monitoring chronic conditions, identifying gaps in care, and promoting wellness. 

Data Analytics: Data analytics allow for proactive patient engagement, whereby sophisticated algorithms are applied to integrated data from multiple sources to predict patients who have a high probability of a risk occurrence and to identify those in need of wellness exams and preventive measures.
 back to ACO list
 
 
Catalyst Health Network, a Texas Healthcare Not-For-Profit company sponsored by StratiFi Health, exists to support independent practices by providing services to better care for their patients AND help them improve and sustain their chosen independent practice model.  Through clinical integration, Catalyst actively manages the health of our practices’ population with care coordination, care management, chronic disease management, and transitional care management.  This is done as an extension of the practices to broaden the scope of services they deliver to their patients.  Catalyst and its members also affiliate and collaborate with other healthcare service providers such as specialists, ancillary services and hospitals to construct, implement and measure clinical pathways that yield better patient experiences and outcomes at a lower and more predictable cost.   
 
In addition to traditional ACO network services, Catalyst’s size and geographic spread allows for an ever growing number of other services that can benefit a member’s practice.  These include, but are not limited to, call coverage, referral management, employee acquisition, and medical student and resident teaching opportunities.

Catalyst members get the benefit of being a member of a multi-payor ACO, meaning over 90% of the patients in our member practices are covered by a value based contract that rewards higher quality and lower cost care provision powered by Catalyst’s services to our members.  Catalyst’s multi-payor model has arisen from our ongoing collaborative relationship with all of the major insurance companies and many local employers to transform the health and wellness of our communities.

Catalyst’s sponsorship by StratiFi Health, an independent practice service company, also provides our physicians unique benefits.   The benefits can include individual practice performance with insights such as financial analytics, revenue cycle management, IT services, operational and clinical workflow assessment along with EMR integration and data reporting.  With the combined two-pronged approach of network services AND practice services, a physician member of Catalyst Health Network has a one-of-a-kind opportunity to maintain a sustainable, thriving independent practice.
 back to ACO list
 
 
Children’s Health Pediatric Alliance - As one of only a few pediatric ACOs in the nation and the first pediatric ACO in North Texas, Pediatric Alliance is positioned as the preferred pediatric partner for adult ACOs and employer groups across North Texas.  The Pediatric Alliance allows adult organizations to complete their offerings for the entire family by adding a pediatric ACO with groups of doctors, hospitals and other health care providers unified to provide high-quality care to children. This organizational model incorporates care coordination into everyday practice while avoiding unnecessary duplication of services and providing enhanced care coordination for children with more complex care needs.
 back to ACO list
 
 
Methodist Alliance for Patients and Physicians is a strong care navigation program with individualized care planning with the most critical beneficiaries.  Nurse navigators are able to break down patient barriers to care by getting equipment, ensuring follow-up, arranging home health services, and providing health coaching.
back to ACO list
 
 
North Texas CIN, Inc. (TXCIN) is an independent physician-led Clinically Integrated Network, engaging ACO contracts with a membership of both primary care physicians and specialty care physicians from three North Texas IPAs and a number of independent single specialty physician groups. We believe a network of both groups makes a valuable impact on patient care by reducing costs and improving quality. Our physicians have access to our referral management tool, which provides members with an opportunity to select preferred providers. Members use this tool to compare provider performance based on their ranking for quality, cost, and response time for referral intake and scheduling. In addition, TXCIN provides care coordination services conducted by nurses and local community health workers. Care coordination programs include transitional care management and disease management programs to reduce readmissions and high-risk cost avoidance by utilizing predictive modeling algorithms to identify patients on a trajectory for high costs. Our Quality Improvement Program utilizes on-site and electronic chart audits of quality indicators for individual contracts and provides detailed performance reports and financial performance improvement incentives (separate from any incentives distributed by payers) directly to members.
back to ACO list


Physicians ACO, LLC (PACO) is an independent physician-based ACO composed only of PCPs. PCPs have risk-based Medicare Advantage Plans through their affiliation with IntegraNet Health IPA and consistently achieve FOUR to FIVE STAR performance each year for the Health Plans that contract with IntegraNet Health.  These PCP Medical Homes provide 24/7 coverage of their assigned beneficiary’s medical needs and coordinate the care received by their beneficiaries.  IntegraNet Health, as Manager of the ACO, provides many care coordination and case management services that augment the effective management of these assigned beneficiaries. The PCPs control and manage the care provided to these beneficiaries, not the Specialists or the Hospitals. This creates incredible value for the beneficiary and lowers the overall cost to the beneficiary and the system in general. Overutilization and duplication of services is minimized and churning of specialists is avoided through our PCP-Driven Model. Our Mission is the “Right Care at the Right Time and in the Right Setting.”   Only through the direct involvement and engagement of the experienced PCP Medical Home is this possible.  
back to ACO list


Premier Patient Healthcare is a physician-owned and physician-led ACO structured specifically to empower and ensure a sustainable, independent future for primary care providers. Independent physicians are at the center of our ecosystem, driving better care for our beneficiaries. This starts with strong physician leadership and participation in governance.  

Premier’s programs and protocols are built with patients and practices in mind. We’ve structured our programs and technology so that the more our physicians engage them, the greater their success. We neither limit, nor charge for, physician access to our programs and technology, encouraging them to embrace as many as they can.

Our proprietary, robust technology platform monitors patients across all settings and applies predictive modeling and risk assessment throughout the continuum of care. The use of data and analytics further facilitates the deployment of care plans to achieve the triple aim—improving patient experience, improving the health of populations and reducing the per capita costs of healthcare.
  
We are constantly looking to the future, anticipating and leveraging changes in the healthcare markets to help our physicians grow and succeed. We do this so they don’t have to, allowing them to focus on fostering healthier patients and building strong businesses in our communities.
back to ACO list


Southwestern Health Resources Physician Network
Care Coordination: Analyzing electronic data, we identify a provider's high-risk patients, and provide predictive information of patients at high risk for hospitalization and ED visit to the providers. The care coordination team works with a patient's care team for total coordination across the spectrum of care. Working closely with the PCP and the care team at a practice level, our care coordinators provide support to reduce readmissions and assist with addressing the medical and socioeconomic issues for high-risk patients.  

Utilization Management & Quality Management: Our UM and QM programs assist physicians with identifying care gaps to more efficiently manage patients, and provide the ability to document and accurately report on the care and quality metrics associated with programs and contracts. We provide support for EMR use and documentation as well as real-time quality performance data to better manage patients and to ensure that our physicians have the knowledge, support and tools to succeed in an incentive-based contracting environment.
back to ACO list


USMD Physician Services is a closed panel entity. USMD employs 216 physicians and 58 associate practitioners. The only participating providers are those within USMD.
back to ACO list


back to top