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Fierce Q&A: How Beacon Health stays independent in an ACO

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Deb Beaulieu

Deb Beaulieu

Beacon Health Partners is a New York-based independent practice association (IPA), recently welcomed by the Centers for Medicare & Medicaid Services as one of its 89 new accountable care organizations (ACO) participating in the Medicare Shared Savings Program. Two of Beacon's leading executives, President and CEO Simon Prince, M.D., and Executive Director Jonathan Goldstein, MBA, spoke with FiercePracticeManagement about their experience forming an IPA/ACO and how this model fits with their outlook on the evolving picture of healthcare, following the Supreme Court's upholding of the Affordable Care Act.

FiercePracticeManagement: There's been some not-so-good news about the future of private practices and physicians' bleak outlook on health reform. How has Beacon accepted and adapted to changes?

Jonathan Goldstein

Goldstein: We look at [reform] as an opportunity as opposed to something that's bad for practices.

I think the doctors see room for improvement in the way we deliver healthcare, and if we can get our heads around that and if we can deliver value versus volume, the docs might see a difference in what's happening, which is Medicare reimbursement decreasing or the constant threat of decrease.

Now there's an opportunity through the bonuses for doctors to get paid for some of the care-coordination services they should be providing but have had a limited financial incentive for performing.

Prince: In 2010, when we started [the IPA], I was president of the medical staff of a large tertiary hospital. A lot of my colleagues at the time were becoming employees of hospital and health systems, and amid the consolidation, there was concern over how private practices were going to make out in all this.

So we came together--right after the Affordable Care Act came out, with the desire to become an ACO--not really understanding what it meant at the time but awaiting the regs.

Obviously, we didn't like the first version of the regs, but it was a way to come together as a private physician network and take advantage of economies of scale and other changes with health reform as opposed to putting one's head in the sand and hoping and wishing it away. Our attitude was to embrace the change and prepare and take advantage.

FPM: How did the process of applying for Medicare's Shared Savings Program build on the work you'd done in forming an IPA?

Prince: We wanted to transform from a messenger model to a clinically integrated IPA.

A lot of the infrastructure that we were planning to put in place was around care coordination, disease management and other clinical initiatives that we're going to need from an ACO perspective. And this really galvanized us and focused us in a direction to execute on our ultimate vision, which is a thriving independent practice association.

We were on the path, and a lot of the things we were already doing made it easy for us to move forward and apply for the Medicare Shared Savings Program for July.