Gregg Masters 00:10 You’re listening to PopHealth Week on HealthcareNOW Radio. I’m Gregg Masters, Managing Director at Health Innovation Media, publisher of ACO.watch.com and your co host with my partner Fred Goldstein, President of Accountable Health LLC, a Jacksonville, Florida based consulting firm. On today’s broadcast, our guests is Nicole Bradbury, Chief Executive Officer of the Florida Association of Accountable Care Organizations also known as FLAACOs. FLAACOs is a statewide community of ACOs that come together regularly to share ideas and best practices. FLAACOs goal is to help member ACOS build and manage successful organizations in order to fully benefit from the changing payment models. To learn more, visit www.flaacos.com. On today’s show, we’ll get both a regional and national pulse check from Nicole on the state of the ACO market, or as more broadly cast in terms of value based care initiatives including an exciting announcement in that space. This is an encore appearance for Nicole for what has become an annual ritual, including a preview of the FLAACOs annual conference to be held in Orlando on November 7 and eighth 2019 at the Omni Orlando Resort at Championsgate. But before pivoting to Nicole first a few words about Accountable Care since the Affordable Care Act was signed into law by President Barack Obama in 2010. Its rollout has been anything but uneventful during the Obama years and beyond. Retooling a massive $3.7 trillion industry is no small task add Health Policy ambiguity and associated political trade winds emanating from DC and beyond including a variable patchwork of State Innovation initiatives. What presents as a complex challenge to healthcare leadership and constituent stakeholders scales to a transformational imperative that continues to challenge even the best and brightest US operators actively pursuing the triple aim that being better experience of care, better outcomes, and at lower per capita costs. As a principle workhorse in the quiver of innovation, arrows. ACOs occupy a central role in the transformation of both healthcare delivery, and finance. So tracking with the various derivative mutations and extensions of ACOs into various models of value based healthcare is a line of inquiry worthy of continued and devoted study. So with no further delay, right over to you, let’s get Nicole’s take on what is most assuredly a dynamic and evolving marketplace
Fred Goldstein 03:08 Thanks so much, Gregg. And Nicole, welcome to PopHealth Week.
Nicole Bradberry 03:11 Thank you always glad to be on the show.
Fred Goldstein 03:14 It’s always a pleasure to have you get some great insights on ACOs and see what’s going on in the Florida market and around the country. Obviously, it’s almost a year now, since we last talked, what’s your sense of where a ACOS are with the new legislation, etc?
Nicole Bradberry 03:26 Well, I think, you know, there’s a lot of fear for what this means to take risks, but there’s a lot of excitement. I think there’s certainly a lot of movement in this space, you know, the pathways of success that came down in the last year and going live 7/1 certainly, you know, fored those high revenue entities, like hospitals to immediately take on risk or get out. And those that are low revenues, kind of independent position lead have a little bit more passed before they have to take risk. But what I’m seeing is a lot of them that have been successful, especially in securing Florida, are embracing it. And then those that aren’t, you know, are sitting back and take it up in the early models, and but but are figuring out how to prepare for that risk. And I think some of that means aggregation, some of that means investments and outside entities, etc, etc, etc.
Fred Goldstein 04:14 So you’re sent from your members and others. I know, obviously, here in Florida, they’ve done fairly well over the time and seem to continue to dig deeper into more risk based models, but you’re also sensing around the country that most of these companies are going to, or these organizations are going to stay in one form or another whether that’s merger or continue on themselves.
Nicole Bradberry 04:31 Yeah, I think, you know, certainly the number of ACOs and you know what those look like there’s going to be change how the ownership is going to change, but the number of patients that are being served the number of providers that are participating, I don’t think you’re going to see much change in that. In fact, I think you’re going to see growth. I just think that the construct of the entities that that oversee them, I think that’s where a lot of the change that happened.
Fred Goldstein 04:55 We’re seeing obviously with some other CMS announcements, the direcy contract in primary care, etc, we’re seeing these pushes to direct contract, do you see the ACOs is beginning to be more of a structure to allow for that?
Nicole Bradberry 05:08 Yeah, I think that all that stuff is, you know, the new models are exciting. I, you know, I’ve always looked at FLAACOs and how we serve our members is a way to help them, you know, down this journey of value based healthcare, not just this MSSP model. And so these are just new models that really are very thoughtful, and how we can bring more dollars earlier on, you know, one of the things that’s always been challenging is the fact that you only get paid for your work at you know, every 18 months or 18 months after you finish the contract. And so or from the beginning of the contract. And so that’s been challenging, because it’s been hard to pay for all the infrastructure and costs that comes along with running these ACOs. And so I think CMS has been very smart, and how can we bring some more upfront dollars? How can we mimic a little bit more how MA works, especially in you know, the Florida markets, where percent of premium has a lot of dollars, that are paid, upfront, and ongoing, versus having to wait until the end. And so I think a lot of that is, is coming in as exciting. And I think you’re just gonna see these ACOs, pivot to these new models, or you’re gonna see other entities come in, that are gonna maybe change the makeup of what we currently think of as an ACO, but all good stuff.
Fred Goldstein 06:22 And so you really beginning to see these, you talked about these, the Medicare Advantage kind of stuff, and these more of a prepaid model say with NextGen, things like that, you go to that you think most of the ACOs, particular here in Florida, obviously, that we’re used to that a bit but around the country moving in that direction, as well and feeling comfortable taking on that kind of risk?
Nicole Bradberry 06:40 Well, I think you’re gonna see bigger entities come in. I mean, one of the things that that, you know, may be challenging for the people that are in it today is that they’re allowing the private sector to come in and own as well as insurance companies that have traditionally led MA but not have anything to do with the fee for service side, they can now come in and own these entities. And so I think you’re going to get a lot of capital infusion because of that. And I think you’re going to see some competitiveness for these members and these docs, from these new organizations that are entering. And so I think maybe if there’s any fear, it’s not that value based healthcare or these models are going to go away, or this momentum is going to slow down, but who’s leading them could certainly change. And and I think that’s probably what, you know, the, the owners and runners of ACOs today probably should be more afraid at than anything is, can we compete?
Fred Goldstein 07:35
It sounds to me, like what you said that some will begin to see, perhaps from a marketing perspective ACOs is trying to sell against each other, much more publicly?
Nicole Bradberry 07:43 Well, you know, I hate to see that happen. Because I think, you know, it’s about getting more and more patients into a value based contract. And there’s enough patients within doctors panels today that aren’t on value based contracts. And I think that should be everybody’s focus. But you know, reality is reality in the market, the market. And I do think you’re going to see competition, and people trying to take other ACOs positions, and therefore their patients, and I think probably more, you know, the challenge is going to be these new entrants are going to come in and form organizations that haven’t been in it before, and then figure out ways to be a capital and resources that currently isn’t available, are going to be able to come in here and truly be competitive and and gobble up Doc’s and patients. So yes, but I hate to see it happen.
Fred Goldstein 08:31 Right. Right. You know, they’re, you’re obviously gung ho on ACOs, they’ve proven very well, here in Florida, there’s some data out of California to begin to show some really good results, but there really has been mixed. What do you say to the naysayers?
Nicole Bradberry 08:46 Well, you know, think about why Florida has been so successful. Think about why, you know, Texas in California, it’s got results, as you know, they did in traditional managed markets, and they’re familiar with, with these type of models, and they know how to be successful in them. And I think, you know, much the rest of the country just hasn’t had skills or the ability to do the same kind of things, at least pivot, how physicians treat patients, etc, then you add to the to that the cost of care is probably less in those markets, there’s less opportunity. And so it wasn’t as easy, low hanging fruit, much less the experience that wasn’t there. And so I think you have all of that, that was against them. But now that you’ve got these models proven and working in certainly driving down costs in in these markets, you’re going to see the leaders and the people that made money there start to creep out into the rest of the country. And so maybe the folks that were running them in the rest of the country might not be leading them going forward. But I wouldn’t be surprised if you don’t see partnership going into those markets from outside that know how to do this stuff that start to to bring more and more value based healthcare there. I don’t think it’s going to stay fee for service. See, what I’m hearing a lot of is MA is trying to go in those markets. And one of the ways they’re doing it is to start ACOs or, or looking at these new direct contracting models, because it’s a way for them to get mindshare into, and then they’re hoping to flip them to MA, I don’t know that I agree that they’re going to be a successful slipping into MA. But the fact that they’re going in, and they’re bringing these patients and these doctors into this new model of thinking and working, is going to change those markets.
Fred Goldstein 10:26 Yeah, that makes a lot of sense. And do you see that brain spreading or expertise spreading around the country coming from companies that are more like an Aledade? Or are those things that perhaps some of these regional ACOs are going to start to say, hey, let’s take what we got and grow it out there,
Nicole Bradberry 10:44 I think you’d see both. And I think you’re also gonna see MA and I think you’re gonna also see Walmart and Amazon and, and traditional payers, who now can put these models, you know, to CMS, and now are now allowed to own these type of models, I think it’s going to come from all points and all the above.
Fred Goldstein 11:01 Great, there’s also been this move by some of the larger corporations, as you mentioned, the, you know, Walmart now doing a commercial ACO with contract with Ochsner in Louisiana. And I think they have some other states as well, is this going to be sort of a pivot for some of these larger employers as a direct contracting opportunity?
Nicole Bradberry 11:21 I think so I think, you know, direct to employer Stuff is happening, you know, in lots of markets, I think you’ve got, you know, traditional MA pairs are trying to go into the fee for services. I’ve even seen a Blues organization trying to grow MA through starting an ACO, you know, and how interesting is that, just because they think they can convert over time, the fee for service members into MA, but they might find they might have profit and premium coming from not premium, but you know, the shared savings, revenue coming from ACO that might make it worth it in and of itself. So regardless, as they go in all these different entities we just talked about go in, they’re going to change how physicians deliver care to their patients. So they’re going to create services and wrappers that are going to impact patients and how they, you know, interact with the health system. And all of that is going to change, and it’s going to create results that haven’t been seen before. And you’re going to create expectations that I just don’t believe that we’re going to, we’re not going to end up with more and more and more patients with value care at the end of this.
Fred Goldstein 12:24 Right. And I think, you know, obviously there are a lot of different models for that whether it’s an ACO model, the hospital setting up their own MA plan, or physicians going globally capitated it’s really sort of, I don’t want to refer to as a rush to risk because there’s certainly plenty not rushing. But I think ultimately, that’s the direction we’re heading.
Nicole Bradberry 12:44 I agree, I completely agree. And, and that’s really always been the kind of charter or mission of FLAACO is really to help our membership, move down this continuum to more and more value based health care. And so you know, whatever it looks like whatever model it is, it really doesn’t matter. It’s really moving down that that continuum.
Fred Goldstein 13:05 So you from your experience, Nicole, for those who have perhaps struggled a bit with their early efforts in in their ACOs, whether it was MSSP, or most of them did, what should they be looking at? Are there cultural issues within their organization? Is it operationally is it trying to move providers? What do you see as sort of the top things they should be looking at?
Nicole Bradberry 13:22 You know, it’s all of that, you know, for sure, but I think it’s wrapping services around their physicians, versus trying to change their physicians and doctors, you know, everybody’s kind of gotten into this and said, We need to transform doctors and how they deliver clinical clinical care, etc. And I just don’t think that’s worked. And I think the ones that have been successful are the ones that really said, Okay, how can we do some of this stuff for them how can we add services? How can we change not what the doctor does, but how we coordinate care between that and so I think people are really starting to latch on to that I’m seeing so many companies that are all about care coordination and and how do we deliver services around doctors versus all this stuff, changing doctors, and that brings in creative analytics and focused analytics that brings in other resources outside of the practices to help and I think all of that is really where I see a lot of success.
Fred Goldstein 14:26 It sounds like we’re talking about population health. We’re actually getting, is that it.
Nicole Bradberry 14:33 Well, exactly. It is that and I think everybody says population health, you’re asking, you know, five people on the street what population health means you probably get a different answer. But to me, that’s what it is. It’s it’s how do we look at this population holistically, not just walking into the doctor’s office, and how do we help figure out who needs to get in and then help get them in there versus trying to change how the doctors in the practices work today and I think the people that have had the most success are the ones that realize that the doctors, for the most part, do the right thing. Once the patient’s in front of them, how do we how do we help get them in front of them? And I think that’s, that’s, you know that, that epiphany shouldn’t be such an epiphany. But I think you know, where you where people see that is where there’s been the most success in this space? ,
Fred Goldstein 15:21 Yeah, interestingly, I’ll ask you this. I’m not sure if you’ve seen this yet or not. There’s been a big push suddenly, from all these health care systems, hospitals, in particular to say, Man, we’re focusing on social determinants of health. We’re getting out in our community housing, food this match, are you sharing any of the ACOs begin to discuss that?
Nicole Bradberry 15:40 Oh, sure. Yeah, I think behavioral health is a huge one, that understanding that behavioral health issues are is probably one of the leading causes of physical health issues. And in coupling those things together. And coming up with solutions around behavioral health, I think almost every entity I talked to is concerned with that. And then for the smaller social determinants around transportation, and you know, housing, like housing, it’s not really small, but things like that, if we can help solve some of those things. And that’s going to have a ripple effect in their physical health care, which brings costs down and brings quality up and, you know, achieves all the things that we’re trying to do within Accountable Care, or value based health care.
Fred Goldstein 16:26 So let’s switch over a little bit to FLAACOs maybe give the audience background on how that started and where it’s at right now.
Nicole Bradberry 16:32 Sure, well, when you know, the first ACO models by CMS back in 2012, first, were approved, and we’re kicking off, you know, I was one of the people that started one of the early ACO’s, I just, you know, looked around my own state, which was Florida and said, Wow, this is the wild, wild west, and everybody’s doing their own thing. And no one’s really the expert in this space. And but everybody’s trying to get in it and be part of it. And so I had formed the Florida Association of ACOs, as a way to just kind of bring this market together to bring these people together. So we can learn from each other, you know, we can not only learn, but we could help each other, we could bring best practices in and over time, that meeting meant bringing the best vendors together to help, you know, with solutions, and it’s really become just a great network place for the innovators and leaders in this space to get together once a year. And you guys have been part of it, you know, from almost the very beginning as well, I think you would agree that it’s a pretty vibrant group of people that are really pushing forward on these types of things, you know, started really, with MSSP, but has grown to be so much more.
Fred Goldstein 17:43 Right,I think, you know, each year, you really upped the game and brought in some incredible people every year. Any idea who’s coming in this year?
Nicole Bradberry 17:51 Well, I have a Aneesh Chopra is our day one keynote, and he was former CIO of the United States. So you know, certainly been involved in opening data for innovation in healthcare. And in fact, he’s got a company that he’s taking the entire Medicare claims database and allowing ACOs and other entities to really understand the doctors, they’re delivering health care today, how are they? Are they ready for is where are they getting their peers, that kind of stuff is really helpful as you’re recruiting and bringing doctors into these models. And so he’s going to be our day one can’t announce by day two yet, because I haven’t finalized it, but might be someone very, in the CMMI group, you know, someone very in the know, and maybe you can shed some light on what’s happening there. As far as our panels, you know, we’re trying to always have two tracks. And day one is really nuts and bolts, how to be successful in Value based health care, and the day two is really focused on these new models and, and you know, what’s coming and how to be successful? And how do you expand into commercial ACOs, how to bring your specialists in with bundles and forward thinking leaders within value based healthcare? What’s next? How do I think a year out? Make sure that I’m ready for that versus the track one, which is really, what how, how can I make this model that I’m in right now successful or more successful? And so I think it’s going to be a great, great conference this year.
Fred Goldstein 19:18 Yeah, I think I should point out that you always while this is the Florida Association of a ACOs, this conference really has a much bigger draw because it has a much broader look in terms of who you bring in. And obviously the fact that Florida itself is successful, the majority of ACOs here have done very well. And so there’s a lot to be learned by those in other states coming into Florida and and spending some time at the conference. You really put together a great group,
Nicole Bradberry 19:42 Thanks we are launching this year and do entity called ValueH. And it’s really embracing what you just said, which is we have been very successful in not only the state but in in going outside of the state of Florida to draw in people that really want to learn from Florida, but also to just learn from the experts that show up. And so, you know, FLAACOs is now part of a broader entity called ValueH, which its mission is across all stakeholders trying to bring those stakeholders together around this space called value based health care. And I think as you come to the conference, you’ll you’ll hear more about that,
Fred Goldstein 20:20 Well, that’s fantastic. I guess. I guess you heard it here first, right, Nicole ValueH. And this new group,
Nicole Bradberry 20:26 ValueH ValueH.com if you want to do a little teaser.
Fred Goldstein 20:29 Yeah, we’re, we’re, we’re breaking news right now to bring you an important announcement. It’s, it’s really great to hear and obviously what you talked about something that’s it’s a broader group of stakeholders, right? Because it’s a ACOs, ACOs and maybe going to other risk models, they may want to be looking at other people going into risk models and vendors as well, that this will tell us
Nicole Bradberry 20:49 it’s it’s payers, you know, it’s it says people focus on social determinants it employer that all the entity CINs citizen health organizations, you know, IPAs that are trying to pivot, it’s all of that it’s how one group that could come together, and figure out how to work together in order to be successful in this change in movement towards more and more value based health care? Well,
Fred Goldstein 21:14 I really applaud you for that. I know, you know, some of the other work we’re doing on the employer side, with some groups validation Institute is all about moving people to value. And obviously, that encompasses a lot of different approaches, requires a lot of different expertise. So it’s fantastic to hear you form this group. And looking forward to seeing how that impacts the conference as well, this year, I’m sure it’ll bring in some different people.
Nicole Bradberry 21:37 I hope so. Yes. And thank you.
Fred Goldstein 21:39 Oh, you’re welcome. Are there any things you see on the horizon that really excite you? Or that it gets you really jazzed up about where we’re going in healthcare? And anything could potentially scare you? Or have you worried that maybe we’re not going to get there?
Nicole Bradberry 21:54 So I nothing scares me? No, other than I think it, you know, might not go as fast as I hope, you know, but that’s just the nature of expectation versus reality. Never fast, as you know, right. But as far as what excites me, I think, you know, we talked about a lot of them already. But you know, the direct to employer stuff to the new models coming out of CMS, the fact that for the first time, some of the commercial payers are even leading what’s coming out of CMS, some unique approaches. And, and I just think all of that, at the same time, just hopefully will speed up how fast this movement happens, you know, certainly the hospitals are lagging behind, because they haven’t figured out how they don’t stay blockbuster and miss the opportunity to become Netflix, you know, they’re still struggling with that one. But more and more of them even are, or at least putting their toes in, you know, they’re focusing more on whole person care, you know, high touch in order to brand they’re the one that cares so that they can offset some of the pull from these entities that are navigating their patients where they wanted to go. But hospitals, I think you’re going to get there. But if anybody’s lagging, it’s probably them. But as far as this movement, I think I think it’s happening. And in my opinion, doesn’t matter which model pushes us down to the right, I do think the independence, I hope they survive this aggregation and this entree from other entities that can come in because I think they uniquely can push more and better outcomes for patients. But at the end of the day, I think it’s about getting everybody off of a fee for service contracts into more of a valye contract. And if that happens, it really doesn’t matter, in my opinion, how it happens.
Fred Goldstein 23:32 And do you think we get to the point where the hospitals are actually looked at looking at themselves as Hey, I need to empty my beds, but I’m going to be okay, because that moved to a risk based contract that allows me to still have some sort of a margin.
Nicole Bradberry 23:45
Well, I mean, and that’s really the journey they have to make is, you know, how do I get dollar one in my physician health organization, and like that become a cost item right now, the beds are a revenue, and I’m seeing it slowly happening, you know, um not as fast as you know, one would hope. But I think the push from the outside entities that are being formed, is forcing them to get there.
Fred Goldstein 24:09
So give us a little sense of where the conference is at this year. I know it’s November 7 through eighth in Orlando.
Nicole Bradberry 24:16 It’s in Orlando, again, you know, our favorite little central part of Florida. We’re going to have it at the Championsgate. Again, which is where we had it last year, they have a great venue and great space for us. And so we decided to have it there another year. I’ll probably change after that. And if you want more information on that, you can go to either ValueH.com or you can go to FLAACOS.com. And Registration is open and help this one’s going to be even bigger than last year. Well,
Fred Goldstein 24:43 fantastic. Last year’s conference was really excellent. And I know both Greg and I are looking forward to coming down for this year and learning and participating as well. So thank you so much for joining us again, Nicole. It’s always great to have you on.
Nicole Bradberry 24:57 You’re welcome and I can’t wait to see your November.
Fred Goldstein 24:59 Fantastic I’ll turn it over to you, Greg.
Gregg Masters 25:01 That will be the last word on today’s broadcast. I want to thank Nicole Bradberry Chief Executive Ifficer of the Florida Association of Accountable Care Organizations also known as FLAACOsand the president for the Florida market of Navis Healthcare for more information on FLAACos go to WWW.CLAACOS, F L A A C O S.com and follow the associations work on Twitter by @FLAACOS and Nicole via @NicoleBradberry. Be sure to check out the agenda schedule and list of speakers for the upcoming FLAACOs ‘s Annual Meeting via www.FLAACOS.com. forward slash annual hyphen conference. This year’s keynotes include Aneesh Chopra, president of Care journey, founded in 2014, under the belief that our nation’s transition to value based care is an important one but one without an operating manual that can reliably deliver on the promise of better health care at lower cost, and He previously served as the first Chief Technology Officer of the United States. He was appointed in 2009 by President Barack Obama and was at the White House through 2012. Additionally, FLAACOs conference attendees will hear from Sanjay Doddamani, MD MBA senior advisor and medical officer at the Center for Medicare and Medicaid Innovation, also known as CMMI. Dr. Doddamani is former Geisinger Health Chief Medical Officer for ACO and home based care. So do mark your calendars for what will be an exciting and informative event for PopHealth Week. My colleague Fred Goldstein and HealthcareNOW radio, this is Gregg Masters saying bye now.