An ACO for UMA Member Physicians

UMA is pleased to announce the establishment of an Accountable Care Organization (ACO) and invites UMA Member Physicians to participate. This ACO, known as Utah Physicians' Quality Care (UPQC), is designed for independent physicians, physician-owned practices and clinics as provided for under the Affordable Care Act. This is in follow-up to our April 1, 2014 meeting where we first introduced the possibility.  The formation of this ACO will allow us to look at negotiating as an entity on behalf of all the independent physicians with third party payers for contracts in the future.

Background Information on ACO and CareScreen

Immediately after the April 1 meeting, UMA started discussions with Accountable Care Associates, Inc. (ACA) or HIE, Inc. and Entities (HIE), a physician owned entity that supports independent physicians and physicians practices and clinics and which has been around for over 17 years. They have had long experience teaching physicians to manage patients and to take on risk when managing patients. ACA is one of the many organizations that established an ACO in the first round of pilot projects authorized through the Affordable Care Act and one of the few ACOs that is earning shared savings. They are also one of the few that established a National ACO.

We are now in the second round of ACO implementation, which began January 1, 2015. Because ACA is physician led, physician driven, and rewards physicians for managing care without penalizing them and without taking money from them up front, the UMA Board and Executive Committee has approved going forward in a partnership with HIE. So, we are establishing a local initiative as part of the National ACO under HIE (I know a bit confusing). Through UPQC, UMA will be running the local ACO part of this National ACO (Physicians Accountable Care Solutions ACO – PACS).

HIE brings many things to the table to help us in our endeavor to allow independent physicians to continue practicing in the future. This partnership and the establishment of UPQC allows us to enroll physicians in the Medicare ACO, thus increasing primary care physician payments for care to traditional Medicare patients as well as enhancing payments for services performed that meet risk reduction requirements established by CMS for patients. HIE has developed a software program/tool (CareScreen) that helps physicians manage their patients and decrease risk of higher cost care (such as hospitalizations) in the future. This tool/program can be integrated into a physician practice EMR or accessed directly through the web. The prompts from the tool on the Medicare patients will increase primary care physician payments drastically.   

If you are interested in additional information or have questions, please contact Lori Donehoo at the UPQC office (385-237-4121).