Gene Farber is COO of Reliance ACO in Farmington Hills, MI. Founded in 2014, the ACO employs 25 full- and part-time staff, and includes 61 practices and 292 physicians. Reliance implemented chronic care management services from CSC in March.
What type of ACO is Reliance? Why was this particular type chosen?
Reliance is physician owned, funded, and operated. The founders had been part of a hospital ACO in the Pioneer model. While it had been successful in saving money, the administrative costs of a large organization meant that the doctors did not see any of the savings. The founders of Reliance believed that a physician-run organization would be more efficient and could achieve the goals of the ACO.
How has technology impacted the ACO’s ability to coordinate care, and begin to move from fee-for-service to value-based care?
Technology is critical to the success of Reliance. We receive ADTs (admission, discharge, transfer alerts) to let us know when patients are in the hospital. We use a care management program from Synapse, which is on a Salesforce platform and allows our staff to access the information wherever they may be via our secure remote desktop computer. We use telephone alerts to securely send information directly to doctors in the ACO about their patients or the programs of the ACO. We link up with skilled nursing facilities to determine where our patients are after they leave the hospital. Technology is involved with every aspect of Reliance ACO.
Why did Reliance decide to implement chronic care management services? How do you foresee CCM impacting patient care and the ACO’s bottom line?
Many of the doctors in Reliance have inquired about CCM. A committee of medical directors reviewed various vendors and felt CSC was a good choice. The hope is that CCM will positively impact patient care. Based on the way the ACO receives shared savings, CCM will negatively impact the ACO’s bottom line in many cases. If the ACO has a large number of patients that receive this service, they have to save double the cost of CCM just to break even because they only receive 50 percent of the savings. I think this will be very difficult to do. Again, just because CMS says a program will save money does not mean it will happen in real life and that is my concern.
What sort of healthcare technology adoption/implementation challenges are unique to ACOs?
The ACO’s attempt to coordinate a large number of practices, most of which have different levels of technological integration as well as different systems. The challenge is to work with many different systems. Reliance also has doctors in at least six different hospital systems, so any integration has to be done separately with each system.
Is Reliance considering implementing additional new healthcare technologies in the near future? If so, why?
We are in the process of implementing our phone app to each doctor. We will be developing a portal for doctors to interface directly into our system, and are planning to develop a patient portal for ACO patients.