Past Meetings

Challenges and Issues Surrounding Accountable Care Organizations

12/13/13  Back

Our December, meeting of Health TechNet was held on December 13th at Nelson Mullins’ D.C. office.

We continued our discussion about the implementation of the ACA and the insurance exchanges. However, our primary topic was the challenges and issues surrounding the formation and operation of physician sponsored Accountable Care Organizations. Of course, provider integration is a pillar of encouraging value-based care under the ACA. But ACO formation, while a worthy goal, has been spotty at best, due to the many organizational challenges and uncertainties about how they will function in different locations.

Our speakers and facilitators for this discussion were Parag Shah and Craig Behm of MedChi Network Services in Maryland.

MedChi Network Services offers practice management solutions to independent physicians and management services to Accountable Care Organizations (ACOs). MNS is a sub-recipient to the Regional Extension Center in Maryland, and in this role became the largest state-designated Management Services Organization (MSO) in the state with 700 participating providers. In addition to the MSO, MNS supported the creation of two physician-led Medicare Shared Savings Program ACOs in July 2012 and a third in January 2013. All three are comprised solely of primary care providers and located in rural areas. Each was awarded Advance Payment from CMS, a competitive non-recourse loan to support certain start-up and operating activities. The ACOs consist of approximately 80 providers supporting over 22,000 assigned Medicare beneficiaries. The practices are becoming clinically integrated and using a care management infrastructure consisting of local coordination, central nurse management, and a robust IT infrastructure for analytics and risk stratification.

Parag Shah is the chair of MNS and all three ACOs. He is the president of Health Prime International, an expert in providing back office business solutions and technology for health care providers. Craig Behm is the Executive Director of MNS and supported the formation of each of the ACOs. He is currently serving as the executive director for the ACOs. In these capacities, both Craig and Parag are driving the success of the private practice of medicine.