shared savings. Medicare’s
shared savings program has
“We have met or exceed-
ed quality requirements
in every single contract,”
says Couch, who excludes
the MSSP program, which
began in January, because
savings won’t be realized
until 2015, but he says they
are “on track.”
ry care practices to be
NCQA PCMHs is one of
four “levers” that Couch
says drives the success of
BSWQA. Putting physicians in charge of care protocols
is another lever because it engages them in the process of
improving the quality of patient care, and that meets the
overall goal of value. Pryor says the principle even applies to
the independent physicians who are affiliated with Baylor
Scott & White only through the BSWQA.
“You can go back to the dark ages, when I used to
practice,” Pryor says with a
laugh. “I thought I practiced
good-quality medicine, but
I didn’t have any data I could
use to improve. My data was in
charts; my charts were paper.
This BSWQA gives doctors the
ability to come under an organi-
zation that is physician-led, get
standard work, and improve as
we move forward.”
The third lever is data. Physi-
cians who join the BSWQA are
required to use the health infor-
mation exchange the system
built to handle the data from
disparate groups of physicians.
The BSWQA dashboard tracks
performance that gives physician members access to reports
that can show metrics at both a system and patient level. Not
everyone is connected to the HIE, but 75% of physicians in
the alliance are expected to be using it by the end of 2015.
The fourth lever is coordinating care for the patient. The
BSWQA has more than 20 health coaches who are RNs to
manage transitional episodes of care. A licensed clinical
social worker is also part of the care coordination team.
“These are nurses who are tasked with reaching out to
that top 5% of patients to be an extended resource and help
them manage their complex disease,” says Couch.
A real-world example is a patient who is discharged with a
prescription that costs more than he or she can afford.
The job of the health coaches “is to solve problems,”
says Couch. “They break down barriers to care with social
services, or anything else. If patients can’t afford it, they’re
saying to the doctor, ‘Give me a low-cost alternative.’ Those
kinds of breakdowns happen all over our country today,
where a patient cannot afford
the drug and is not taking
the drug, which can result in
The BSWQA is financing
its transition to a value-based
reimbursement system, in part,
with its payer contracts. The end
result of care coordination, big
data, medical homes, and care
protocols may be more cost effec-
tive in the long run, but setting it
up is a big investment up front.
“When we strike an agreement for these accountable care
contracts, we require the payer
to pay us for services on that
nurse on day 1, even though
I may not earn a savings until
the following year,” says Couch.
“We won’t sign a contract unless they do.”
Couch says no payer has walked away yet, likely because of
the large geographical footprint that the health system has
in north central Texas.
Physicians and specialists are not walking away either.
Couch says the BSWQA will always be open to primary care
physicians, but it has suspended new entries for specialists,
with geographic and strategic exceptions.
Chung, who has been a BSWQA member for two years,
says he anticipates seeing more patients as more payer
“Frankly, we have a
of physicians. They have
different expectations of life
once they graduate
with an MD degree.”
NOTE: This chart includes data segmentation from the Premium edition of the reports.
SOURCE: Health Leaders Media Annual Industry Surveys for 2015, 2014, and 2013;
FINANCIAL FORECAST AMONG PHYSICIAN ORGANIZATIONS
When describing their financial forecast for the fiscal year, Industry Survey respondents from
physician organizations are largely positive in 2015, in line with the previous two years.
2015 2014 2013
Strongly positive 8% 13% 11%
Positive 55% 46% 54%
Flat 28% 31% 25%
Negative 5% 7% 7%
Strongly negative 1% 2% 1%
Don’t know 2% 2% 2%