But not all ACOs are alike, says Steven Ullmann, a health policy expert at the University of Miami business school. He says some highly successful ACOs have been around for a long time, such as the West Coast’s Kaiser Permanente, which is a comprehensive umbrella that includes insurance, hospitals and doctors in one system that emphasizes preventive care. The best long-standing ACOs are nonprofit and are well accepted in their communities, creating a culture in which pregnant moms start with obstetrics and the kids grow up through pediatricians, primary care docs and geriatricians. But these programs aren’t always easy to adapt to other locations.
In Miami, Florida Blue is trying an ACO as part of an informal organization with Baptist Health South Florida and a group of Miami oncologists. Others, like the Miami group that boat mechanic Pinto is part of, are created by doctors and don’t include hospitals.
Pinto is a patient of the South Florida ACO, which was set up this year by 75 Miami-area doctors who wished to control their future rather than be forced into some big entity’s structure. “We simply want to focus on the practice of medicine,” said Jorge Acevedo-Crespo, a Miami pulmonologist who heads the ACO.
About half of Acevedo-Crespo’s practice is internal medicine, meaning primary care, and one of his patients is Pinto, who already had a “bad experience” with an HMO that “promised many, many things,” but made it hard for him to see specialists and have tests done.
Pinto was asked to join the ACO’s board as a volunteer patient member, and has been happy with the freedom it allows him. One example: Pinto continues to see a Coral Gables pain specialist who is not part of the ACO.
Unlike long-established systems like Kaiser Permanente, Acevedo-Crespo says his ACO doesn’t restrict patients to doctors within the organization because its goal is to get other physicians — such as the Gables pain specialist — to join the South Florida ACO.
“Even as it is, we work closely together,” Acevedo-Crespo said of his relationship with the pain doctor. “I pick up the phone and talk directly to him, discuss what we’re going to do next. We are practicing state-of-the art, evidence-based medicine,” rather than being part of an ACO run by “big insurance or hospital chains or investors or have a Wall Street company asking where are the dividends going to come from.”
Ullmann at UM says South Florida ACO is an example of fledgling setups being approved by the feds in the hope that they can grow into an integrated system involving hospitals and others. Ullmann says some new ACOs are surprised at the high costs to set up a coordinated infrastructure, such as electronic records, and he expects at least some new ACOs to eventually disband.
South Florida ACO has avoided the cost problems, says Acevedo-Crespo, because it has teamed with an already-established doctor-owned group, Palm Beach ACO, which is providing the back-office infrastructure to the Miami group.
Another form of medical coordination, working on the same theory as ACOs, is what is officially called a patient-centered medical home. They’re intended to offer primary and coordinated care easily accessible to patients, usually through the office of a primary care physician. Florida Blue, the state’s largest insurer, has already put 700,000 patients in medical homes.