Pioneer ACO Atrius Health and Herding Cats

Herding cats…an idiomatic saying that refers to an attempt to control or organize a class of entities which are uncontrollable or chaotic, according to Wikipedia.

You can even search YouTube with the phrase “herding cats” and find some entertaining results, my favorite being 100 cats set lose in a huge department store.

One cat gets stuck behind a wall requiring a hole to be cut for its rescue; another escapes the inescapable area set up to contain the felines.  I kept thinking, who came up with this idea, and why did store management ever agree to it?

So does healthcare possibly offer a similar paradigm?

  1. What if you had 100 physicians…or maybe a 1,000, set lose to treat patients, as each determined best.
  2. Can you imagine the outcomes, the variations?
  3. What if these docs could refer to other docs and then those docs could refer again to other docs.

This is a scenario that Atrius Health, one of 32 Center for Medicare and Medicaid Innovation (CMMI) Pioneer ACO’s, calls “Malignant Outside Utilization,”or MOU, which is when uncontrolled and rampant referrals expand outside their physician network for their covered beneficiaries.

Atrius Health is managing MOU by leveraging clinical & business intelligence (C&BI) techniques.  Using the Medicare claims Medicare their beneficiaries incurred, Atrius Health is tracking the referral patterns of their physicians to those inside and outside its network, the resulting referrals from those referrals, and so on.  Using this analytical technique to identify deep referral patterns, this Pioneer ACO can then take measures to address at the source where the referrals start.

This creative and intuitive approach – to understanding healthcare and clinical business using analytics and “big data” – designates Atrius Health as a true pioneer.

For more information, download the white paper from HIMSS Analytics sharing how Atrius Health strategically deploys C&BI and analytics.

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2 Responses to Pioneer ACO Atrius Health and Herding Cats

  1. Katherine Ann Roberts MD FACE says:

    Malignant Outside Utilization.

    In a blog article for HIMSS (Heath Information Management System Society) about herding cats, James E. Gaston of Atrius Health is trying to manage doctors by employing various questionable tactics.. His aim is to eradicate “‘Malignant Outside Utilization,’or MOU, which is when uncontrolled and rampant referrals expand outside their physician network for their covered beneficiaries.” He discusses how this happens in his one of 32 Center for Medicare and Medicaid Innovation (CMMI) Pioneer ACO’s.

    Wow, UNCONTROLLED and RAMPANT referrals can really do a doozy on an ACO. I read the MOU to mean that there are physicians who refer to the best physician whom they know for a certain problem, and they refer to the best physician whom they know for a certain, and so on, and so on, and so on, … This might be HORRIBLE for their business model but it can be GREAT medicine and could save not only lives but also money in the long run!

    I have problems with any person or business, which impedes peoples’ freedom of choice, especially when it comes to choosing what is best for their own health. After all, their lives depend upon this! This is particularly of concern in smaller areas, where hospital groups, physician groups, ACOs and Clinically Integrated Networks (CIN) seriously hamper the choices of the physicians and the PATIENTS. We can still have patient center medical homes with LOTS of neighbors. But I don’t like the restriction of the choice of the specialist physician by forces outside the physician- patient relationship. In a perfect world – everyone should have always had a patient centered medical home with their primary care physician and/or their endocrinologist if he/she is their point person. However, everyone should be their Neighbor.

    In my little area of Virginia, there are three main groups which take care of our population, which is approximately 1/3 of the 1.6million of the Virginia Beach-Norfolk-Newport News VA-NC MSA. The groups are trying to buy-up or integrate in a CIN everyone in the area. Two of the groups each have two endocrinologists and the third group has no one specifically “owned” by their group. They have a couple who come over from the medical school in Norfolk and there are some part-timers. So there aren’t many from which to choose for the 5-600K patients in the area. I am solo. I am not a renegade or maverick, I just believe that the patient deserves the best care possible; and I did not think that it was possible to do so by working for the groups in the area. [They have this thing about seeing patients every 10-15 minutes, no matter how complicated the diagnosis or the patient, which I really don’t like. Also, the radiologists are the only ones who are allowed to have ultrasound machines, and I really like doing my thyroid stuff. But that is beside the point. ]

    My practice depends upon my colleagues in the area to refer to me or to allow their patients to request my services – therefore, they are falling under the category of MOU. Because I am not owned by their hospital or physician group, I am one of the BAD doctors who refers next to whomever I believe is the best physician to serve the needs of the particular patient.

    I was at two different dinner parties recently; a friend in a GI group told me that one of her longtime patients was referred away from her because she was not in the new PCP’s group. The patient ended up coming back after a few years when she found out it was not true. Another was a Neurologist, in one of the big groups, who was told by a patient that a Neurologist in the other group said she could not be referred out of their group.

    The plans of all of the insurance companies, ACOs, and CINs are to end up with ONE controlled set of doctors and patients. (ACOs and CINs are not bound by Stark Laws so they are setting up monopolies.) They say that their structure is so that all the providers have access to the same information. There are better ways to accomplish this without reducing everyone’s freedom of choice and quality of care.

    Okay – I know that this is a round – about way to say this, but if we do not want all of our choices and our freedoms in practicing medicine to vanish – WE MUST DO SOMETHING! We must strengthen and protect the patient – doctor relationship!

  2. Cayla Cook says:

    Thank you for every other magnificent post. Atrius Health formed in 2004, is a not-for-profit, 501(c)(3) tax-exempt organization, and is the largest independent alliance of community-based physician groups (Dedham Medical Associates, Granite Medical Group, Harvard Vanguard Medical Associates, Reliant Medical Group, South Shore Medical Center, and Southboro Medical Group) in Massachusetts. Keep it up!

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