The Centers for Medicare & Medicaid Services (CMS) want all traditional Medicare enrollees in accountable care organizations (ACOs) by 2030. As one means of accomplishing that goal, the federal agency is revising the Medicare Shared Savings program’s fee schedules to entice physicians to sign on with ACOs.

But will the carrots that CMS is dangling in front of clinicians eventually be accompanied by a stick? With the Medical Group Management Association estimating that value-based payments made up only about 7% of primary care revenues in recent years, achieving 100% enrollment in ACOs by 2030 is likely to require a significant policy push, one that may pose new challenges to the independence of primary care practices. Past government initiatives (think electronic health records and “meaningful use”) were major factors in the last wave of practice consolidations, a wave that took on tsunami-size proportions when COVID-19 arrived.

A report from the nonprofit Physicians Advocacy Institute found that from 2019 through 2021:

• 36,200 practices were acquired by hospitals or other corporate entities — a 38% increase in the percentage of corporate-owned practices;
• 108,700 physicians became employees of hospitals or other corporate entities — a 19% increase in the percentage of physicians practicing as employees; and,
• the proportion of practicing U.S. physicians employed by hospitals or other corporate entities increased from 62.2% to 73.9%.

So what should those primary care clinicians who have weathered the storm — and pandemic — to remain in independent practice make of the latest CMS goals and incentives?

In answering that question, physicians need to weigh a few factors, including:

• the percentage of their practice revenue currently derived from Medicare;
• the likelihood that Medicare beneficiaries will represent an even larger proportion of their practice population in the years ahead, as the last cohort of baby boomers reach age 65; and,
• the fact that commercial insurers tend to adopt or adapt Medicare approaches, such as shifting away from fee-for-service (FFS) reimbursement to a system that rewards efficiency and outcomes.

Based on those considerations, participating in a Medicare ACO might seem worth pursuing, but what exactly is an ACO, and can a primary care practice participate in one without surrendering its independence?

ACOs: A Working Definition and Implications for Independent Practices

Simply put, an ACO is a networked team of physicians, other health care professionals, and hospitals that come together to provide patients with the best-coordinated care at the lowest possible cost. Through communication and collaboration, team members provide accessible, comprehensive care. By coordinating effectively, they can take a proactive approach to managing chronic conditions and other illnesses, pre-empting avoidable Emergency Department visits and hospital admissions, duplicative tests and unnecessary services.

ACOs were created to facilitate the shift from the fee-for-service reimbursement model — in which physicians are rewarded based on quantity of services provided — to value-based, in which physicians are rewarded when their patients do better.

As CMS explains, “ACOs are designed to put patients at the center of their care and help them navigate a complex health system. Patients whose health care provider participates in an ACO may get:

• extra help managing chronic diseases
• coordination between different doctors or members of their care team
• more preventive health services to keep them healthy
• additional recovery support when they come home from the hospital
• care in more convenient ways, like care based at home or through telehealth or other virtual means.”

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Given that emphasis on coordination of care, do participating physicians all have to be employees of large health care systems?

Vytalize Health answers that question with a resounding “No!” One of the nation’s fastest-growing Medicare ACOs, Vytalize has helped more than 3,000 providers maintain their independence while still sharing in the clinical and financial benefits of ACOs. This special section will highlight the philosophy and approaches that have made Vytalize attractive to so many primary care physicians, and also will outline key considerations to weigh when thinking about whether an ACO makes sense for you and your practice.

How One ACO Enhances Outcomes, Patient Satisfaction and Physician Revenue While Reducing Unnecessary Costs:
The Vytalize Approach

Amer Alnajar, MD,

“Teamwork makes the dream work” is the mantra in health care these days, but how well are the top-down approaches imposed by integrated delivery networks working for primary care physicians?

Not so well, according to a survey of 555 family physicians, internists, nurse practitioners and physician assistants practicing in a large network. The study’s authors found that “PCCs [primary care clinicians] in integrated health systems feel many of the same pressures as their counterparts in nonintegrated settings, but they are also confronted with unique stressors related to these systems’ organizational features that restrict clinicians’ autonomy.”

That’s why internist Amer Alnajar, MD, set out to create an accountable care organization (ACO) in which his fellow primary care clinicians were at the center of the health care team, surrounded by the specialists and services they needed to provide quality care to their patients. And to ensure that those primary care clinicians had the analytic tools they needed to practice effectively and the reimbursement mechanisms that rewarded that effectiveness, Dr. Alnajar partnered with international business consultant Faris Ghawi, MBA, to create primary care-centric data-sharing systems and compensation structures.

As that Medicare ACO, Vytalize Health, approaches its 10th year in operation, its 3,000+ providers can draw on a wealth of resources, including:

• virtual and in-home clinic to support patient care between office visits;
• identification of care gaps and actionable insights by analyzing clinical notes, claims, social determinants of health data and hospital feeds; and,
• integration with high-performing systems of care, including hospitals, specialists and ancillary care providers for end-to-end care management.

Those services and others provided by Vytalize have enabled its participating physicians to achieve impressive clinical outcomes without selling their practice to a corporate entity, becoming a hospital employee or otherwise sacrificing their autonomy.

Key performance metrics include:

• 41% reduction in emergency department (ED) utilization
• 38% reduction in hospital admissions
• 17% increase in patient retention
• 9% cost savings — which are shared with clinicians

Receiving Shared-savings Payments Now, Not Later

Economists like to talk about the “time value of money,” which boils down to the fact that it’s better to be paid now than paid later. In creating Vytalize Health, Dr. Alnajar and Ghawi recognized that physicians’ frustration with shared-savings programs involved both the amount of money they received and when they received it.

“In talking with physicians as we developed our plans for Vytalize Health, a major complaint that came up time and again was how long they had to wait to receive payments for providing value-based care,” explained Ghawi, who serves as Vytalize Health’s CEO. “The clinician had provided excellent care, and the patient had benefitted, but months went by before the accountable care organization, integrated delivery network or other entity shared the resultant cost savings with the clinician. We determined from the outset that we were going to be different.”

For Vytalize Health, that difference means payment of projected shared savings amounts in advance. In 2021, the average primary care physician fully engaged with Vytalize Health received more than $50,000 in shared-savings payments. That amount is projected to increase to roughly $150,000 for the current annual period.

How is Vytalize Health able to achieve and share such savings? Not by limiting care. In fact, Vytalize patients see their primary care provider 78% more than the average Medicare beneficiary — and providers have three times more time to spend with each patient compared to national norms for office encounters. Dr. Alnajar explained that, beyond increasing patient satisfaction, this high degree of access facilitates more effective management of chronic conditions and prompt identification and treatment of any new health issues, which ultimately reduces costs.

“When physicians and advanced practice providers are freed up to do what they do best — take care of patients — good things happen,” the internist added. “When those clinicians’ efforts are supported by a team providing virtual care, in-home care, care coordination and data analysis — such as we do at Vytalize Health — good clinical outcomes are accompanied by strong financial performance.”

What Makes Vytalize Health Different from Other ACOs

Vytalize is structured to enable primary care providers to do what they do best — treat patients — and gives them the time and resources they need to treat their patients in a way that closes care gaps and enhances outcomes. The table at right shows how the division of responsibilities at Vytalize differs from that of other ACOs — to the benefit of patients and clinicians alike.

At Other ACOs
Practice’s Responsibilities:
Treating patients
Closing ACO care gaps
Quality reporting
Uncompensated care coordination
Data analysis
ACO’s Responsibilities:
Potential shared savings – 2 years later

At Vytalize Health
Practice’s Responsibilities:
Treating patients
Closing ACO care gaps
ACO’s Responsibilities:
Value-based incentives
Data analysis
Virtual care
In-home care
Care coordination
Downstream network management
Payer contracting

Take a ‘Vytal Step’ to Earn Payments This Year and Position Your Practice for Success in 2024

Since its founding in 2014 by internal medicine specialist Amer Alnajar, MD, and Faris Ghawi, MBA, Vytalize Health has grown rapidly, with its primary care-centric approach and commitment to sharing cost savings with participating physicians prompting more than 3,000 providers to sign on.

For 80% of those physicians, participating with Vytalize Health represents their first involvement with value-based medicine. And the overwhelming majority are glad they did, with 95% of participating physicians choosing to remain in the Medicare ACO, enjoying its benefits while retaining their independence.

A snapshot of Vytalize Health’s growth from 2021 to 2023

One New Jersey Internist’s Experience with Vytalize Health

Angelo Chinnici, MD,

Angelo Chinnici, MD, didn’t like the pattern he saw emerging, but in this case, it wasn’t a steady rise in a patient’s blood sugar levels or a change from one year to the next in another patient’s imaging studies. Rather, it was a development that threatened the health and independence of the primary care practice he had built over many years in Asbury Park.

“Ten years ago, I saw an evolving trend of big corporations and hospitals trying to gobble up private practices,” the internal medicine specialist explained. As Dr. Chinnici evaluated how best to protect his practice from that threat, he investigated Vytalize Health and decided that affiliating with the accountable care organization (ACO) was the best remedy for relieving the pressure to sell his practice and for addressing many of the challenges related to the everyday operation of a practice.

“I realized that I could maintain my autonomy yet enjoy collaboration with a cohesive group of internists so that I have more financial power and more backing in caring for patients,” he said.

“Vytalize has brought about a new culture in patient care,” Dr. Chinnici added. “I now interact with a group of five physicians who are all Vytalize members and who share a call schedule, hospital records, and urgent care visits. This has greatly enhanced my ability to follow patients and navigate through the system. I would firmly recommend Vytalize. If you’re contemplating joining an ACO, Vytalize is going to empower you to negotiate fees with insurance companies as well as render care in the way patients deserve.”