South Florida Hospital News
Saturday July 11, 2020

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October 2015 - Volume 12 - Issue 4


The ACA Train Has Left the Station: Are You on Board?

With the creation of health insurance exchanges, expansion of coverage, and potential tax penalties, Title I of the Affordable Care Act has received most of the local and national attention. Despite how legislatures may address these controversial elements in the future, the ACA train has left the station and Title III is the engine driving it into the future.

Title III is subtitled “Transforming the Health Care Delivery System,” and sets out structures for linking payment to quality outcomes under Medicare, a strategy to improve healthcare quality and encourage new patient care delivery models such as Accountable Care Organizations or ACOs.
The ACA has been the catalyst to nudge the industry to reform the delivery system from volume to value. Consider this January 2015 announcement from Health and Human Services Secretary Sylvia M. Burwell:
“HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018….”
At Holy Cross Hospital in Fort Lauderdale and Trinity Health, we have been focusing on “Transforming the Health Care Delivery System” by pioneering new patient care models such as clinically integrated networks (CIN) and patient centered medical homes.
The Supreme Court hadn’t ruled on the ACA when we launched our CIN, Holy Cross Physician Partners in 2011. Today, hundreds of physicians in Broward and Palm Beach counties are united in the premise that better quality, higher patient satisfaction and lower overall health care spending come from a deliberate, coordinated effort between partner physicians.
Holy Cross Physician Partners is now an ACO with Florida Blue, Aetna, Cigna and Medicare, caring for nearly 40,000 lives. In doing so, we have fully embraced the spirit behind the letter of Title III, which can best be described by the now ubiquitous Institute for Healthcare Improvement’s Triple Aim framework: (1) improving the patient experience of care, (2) improving the health of populations and (3) reducing the per capita cost of healthcare.
With a focus on population health management, we are creating a more patient-centered, holistic model of care. Care coordination nurses on the hospital floors and in primary care offices examine patients as our ACO nurses do telephonic outreach to patients to follow up on ordered tests and care plan compliance; all of them linked to patients through shared care plans easily accessed by caregivers.
We’ve moved from considering what condition or procedure led a patient to our door and started giving equal attention to if they have what they need when they leave, and we keep closer tabs on them after they’ve left. Before and beyond any given episode of care, we are committed to being their healthcare partner for life.
The ACA helped create an environment where investing in infrastructure and cutting edge technology makes that possible. Internal clinical records are now combined with data from all payers to create a more comprehensive picture of a given patient. For example, we quickly knew that a Holy Cross ER patient had been treated in New York and promptly received records and communicated with the New York care team.
This leads to another result of the ACA: it has compelled providers to think about partnerships in new ways. Earlier this year, Holy Cross Physician Partners and Memorial Health Network in Hollywood created Atlantic Coast Health Network, a regional CIN that will collectively boast 1,400 physicians and 95,000 lives.
It’s hard to predict how the ACA will drive future developments but it's clear that delivery system and payment reform is accelerating faster than many predicted. It is not out of the realm of possibility that one day CINs might contract directly with employers or assume some of the risk and create joint products with insurance companies.
A train is a powerful machine that starts slowly from a standstill, gains speed and momentum and is difficult to stop. Title III of the ACA may have gotten the train started, now commercial payers are hitching up cars and there’s little doubt that we will wind up some place very different than where we started.

Shawn Franklin is Executive Director of Holy Cross Physician Partners. He may be reached at (954) 351-7890 or

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