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Our Take: Review: exl’s 12th Partering with ACOs and IDNs Summit

Nov 05, 2018

I’m taking the helm this week to share my experience presenting at a conference last week, and lessons I learned from two days of sessions. We will return to our regular format next week. The conference, exl’s 12th Partnering with ACOs and IDNs Summit, included about 100 people, mostly represented by pharma, ACOs and health systems. There was a handful of consultants like me milling about as well.

– J.M.

ACO Executive Survey
In the first part of my presentation, “Trial and Error—How to Effectively Partner with ACOs and IDNs,” I reviewed some of the data from our most recent online survey of 105 ACO executives. Below are some of the areas I emphasized.

1. ACO executives said their most pressing problems include having access to timely data from payers (61 percent), EHR system interoperability (60 percent), lack of patient engagement (51 percent) and lack of physician engagement (49 percent). These four areas have topped our list for three years running.

2. When asked to describe their level of technology integration, 44 percent of the respondents said that physicians and the hospital are mostly on separate EHR systems, compared with 66 percent who said so in 2017. While we saw improvement here, this remains a problem. An ACO will underperform without technical integration among providers. In our survey, only 25 percent said that all or most physicians are on the same EHR.

3. In addition to the usual suspects—controlling costs, reducing readmissions and unnecessary ED admissions, improving physician engagement—executives said their strategic priorities include managing practice variation, improving the use of data, and focusing on care transitions and better coordination of post-acute services.

There’s more, but I’ll stop there. If you are interested in our upcoming revised version of ACOs and Value Based Care 2019, which includes a chapter with the survey results, email me at jm@darwinresearch.com.

Pharma-ACO partnerships
The second half of my presentation was focused on how pharma can—and should—collaborate with ACOs. After all, that was the theme of the conference.

In my experience, pharma has largely ignored ACOs as a viable partner. There are a variety of reasons for this, not the least of which is a general lack of understanding exactly what an accountable care organization is. I often hear the terms IDN and ACO used interchangeably, but IDN (integrated delivery network) is a common term within pharma that refers to an integrated health system that includes hospitals, clinics, physician groups, post-acute services and sometimes an insurance product.

When I asked the audience how many of them had participated in some form of ACO-IDN partnership, not a single hand went up. I asked why.

“Stark,” one person said.

But that’s not true. Michael Barrett, founder of CURA Health Management, noted in his presentation that he has implemented programs with various providers through a waiver that ACOs can use to bypass Stark and anti-kickback laws. As long as the partnership seeks to accomplish at least one of the three Triple Aim goals, has a written agreement and gets approval from the ACO governing body, an ACO can apply for the waiver.

I asked Dr. Curtis Page, CEO of Commonwealth Primary Care ACO, about partnering with pharma six months ago in an interview for Health Care Rounds. You can listen to the clihere if you’re interested. (The question comes at 4:50 into the conversation in Part 3.)

“If a signature drug comes along that can dramatically improve heart failure outcomes, now what we need is … to have pharma come in and fund a heart failure program,” Dr. Page said. “So they would come in, they would fund some scales in the home, they would fund some nurses to take calls, they would fund some education for the doctors in the practices …. And what we would make sure as providers is to make sure they use this drug that has proven outcomes.”

Instead, he says, he gets a few brochures to hand out to patients, “falling way short of what we need” for a successful heart failure program.

Getting to strategic collaboration
Let’s face it: ACOs are small businesses, or small units within a larger organization. They’re often cash strapped. As one presenter pointed out, 18 months can pass before an ACO 1) gets paid, and 2) knows whether it earned shared savings. Done right, a pharma partnership can significantly move the needle on quality and patient outcomes, and could help an ACO earn shared savings in the process. A win for patients, a win for the ACO and a win for pharma.

A final reason pharma shies away from ACOs is a lack of enthusiasm for branded programs. Again, that depends on the ACO. We learned from the conference that an ACO might not mind if an education program was labeled “Novo Nordisk Diabetes Care” or “Novartis Oncology.” That’s a regulatory issue that would require sorting out at the home office.

Scott Hylla, director of health systems-managed markets for Sunovion, described three levels of partnership in his presentation: Transactional, Collaboration and Strategic. It’s safe to say that pharma has yet to enter the transactional stage with ACOs. It isn’t yet viewed as a partner at all. But there are opportunities to move toward a strategic partnership through education, data sharing and financial support that improves patient care.

There are other ways to work together, too, if both sides are creative.

“Pharma must start with the relationship between the company and the ACO. Patient education, partnerships for population health management, physician education—each of these strategies can demonstrate pharma’s commitment to a collaborative, working relationship to achieve high-quality patient care. Pharma knows how to do this kind of customer service well; it has perfected it along the way with managed care years ago.

“Beyond this initial level of partnership, pharma needs to quantify the benefits of their drug as it relates to the ACO patient population. In addition to being committed to good clinical outcomes, ACOs are financially driven entities. It isn’t enough to produce a back-of-the-envelope cost-benefit analysis. If a drug reduces rehospitalizations, ACOs want to know how much, down to the dollar, they will save.”

Let’s pause for a moment while I call your attention to those last two paragraphs. I wrote that in August 2014. And I probably had some version of it a year before that.

Let that sink in.

One more thing
Everything I’ve described here applies to many other suppliers and providers. So, if you’re an independent home health care provider, or a manufacturer of a new health care technology, you might also find value in partnering with ACOs.

For example, Dr. Daniel Durand, vice president of clinical strategy and chairman of radiology for LifeBridge Health, talked about a new retinal scanning technology that had been deployed to primary care offices, in partnership with the manufacturer. This technology allowed for patients with diabetes to be scanned during their wellness visit, eliminating the need for a separate appointment with a specialist. That step—which didn’t affect physician workflow—undoubtedly picked up cases of mild retinopathy that might have been missed.

The ACO-manufacturer partnership saved a few patients that were on their way to blindness, and LifeBridge has data that suggest that’s the case.

The partnership also would eventually save a few Medicare dollars and, in turn, the ACO. Medicare spends almost twice as much on blind patients as non-blind patients.

This conference was about pharma-ACO relationships, and attendees from both sides were eager to learn and participate. We’ve also noticed an increase in interest in the ACO model from our clients. My sense is that we’ll see a few notable pharma-ACO partnerships launch in 2019.

Contact Darwin Research Group and we will get right back to you.