Leveraging the ACO Infrastructure at UNC Health Alliance

Oct. 11, 2021
Transitions-of-care program launched for one value-based care program has been scaled up for the entire health system

Can health systems leverage the infrastructure set up to manage an accountable care organization to make broader systemic changes? At the recent NAACOS fall conference, Mark Gwynne, D.O., president and executive medical director for UNC Health Alliance in North Carolina, described his organization’s progress in doing just that.

UNC Health Alliance oversees the University of North Carolina's clinically integrated network, next-generation ACO and population health services organization.

“Leveraging the infrastructure of an ACO across market segments, across populations and across our healthcare system is the trajectory for how we deliver better care,” Gwynne said. “When I talk about infrastructure, what I mean is people, processes and technology.”

UNC Health Alliance was created in 2015. Its first entry into risk was in the next-gen ACO program in 2017. “That gave us the platform so that we could start to talk about value and how to manage high-risk patients differently than we've done in the past, not just in our clinics, but in our hospitals, our EDs and our post-acute facilities. We started those relationships that we're now leveraging across lots of different market segments.”

UNC Health Alliance has since grown to 14 value-based contracts across Medicare, commercial, Medicaid and Medicare Advantage markets.

Over the past two years, the UNCHA Network has realized more than $100 million in new “direct value revenue,” which Gwynne defined as their portion of shared savings and quality incentives, while achieving the highest quality performance across populations.

The clinically integrated network includes 7,200 providers across North Carolina — about one-third primary care, two-thirds specialty care. “Fundamentally, we believe that value-based care and population health risk management is rooted in good primary care,” Gwynne explained. “We also have a third of our network as independent providers, two-thirds as employed providers. That's an interesting mix as well. We learn a lot from each other between our employee network and our independent network.”

In his presentation, Gwynne used a car metaphor, referring to the clinically integrated network as the chassis and the services as the engine. The network is an alliance of physicians, hospitals, and post-acute specialists aligned to improve care and reduce cost while optimizing health; the services include their APM portfolio in addition to clinical and operational services, quality improvement, finance and analytic support.

He said that part of what they are trying to do by leveraging their ACO infrastructure is to change the culture of all of the executives and frontline care providers across the system.

“We started as this little ACO office on the side. We had our population health services group that had been doing really good work for about a decade, and we had our clinically integrated network. About three years ago, we decided to integrate all three of those. They are all managed jointly,” Gwynne explained.All of our decisions across contracts, across populations, across financial investments come from this group. That has changed the trajectory of our work because we have this organization from a healthcare system standpoint now. The independent providers in the clinically integrated network now have a way to participate in value. They can leverage our services around population health management and community engagement.”

As an aggregator of independent providers for North Carolina, he said, they can drive strategy around value-based care. “We can drive changes in hospital operations, or at least help contribute to that, and coordinate all of our quality initiatives across the system — acute care quality as well as our ambulatory quality.” UNC Health Alliance started with supporting primary care, then developed and added services and capabilities to support communities and families to focus on some of the social drivers of health outcomes. “We have increased the populations covered under value-based care,” Gwynne said.  “We have about 350,000 lives at risk, either currently at risk or with a clear contractual path to risk over the next 12 months, and about 650,000 if we include just pay-for-performance quality.”

He mentioned what could be referred to as the chicken-or-egg question: Do you build the services and then bring in the contracts or do you go get the contracts first and then build the services? “What we found over time is that we've done both,” he said. “We started with a very core set of services and teams and added a contract or two and now we're really looking to bring in contracts that we know we can do well based on our services, our financial infrastructure, and everything else.”

In terms of leveraging infrastructure across markets and across populations, Gwynne said, they have tried to thread that needle between centralized services that meet the needs of value populations, but also translating into the priorities of the healthcare system, while managing embedded resources primarily within primary care that meet that office's needs.

Here is one example: “We started with a very small transitions-of-care team doing work for one value population, and it was really effective and successful,” he explained. “We then translated that into a transitions program that we manage for the entire system. All of our hospitals, most of our providers, and many of our EDs utilize our transition services. It's a population-based approach to transitions of care that we've built over time that we know is successful, that we know there's a return on investment for. It actively reduces readmissions and returns to the ED. It's an effective process that now we've scaled it across the system because we can link that to reduced readmission penalties, for example.”

As UNC Health Alliance has focused on some centralized services, it also has tried to use a data-driven approach to embed services within primary care. “We look at the makeup of a practice and we design what we think is the right care team, whether it's a nurse, licensed social worker, registered dietician, a pharmacist — whatever is appropriate for that practice in that community,” Gwynne said. “We also have a portfolio-level look across all of our contracts and look at the financial risks, the population risk, the utilization patterns, and we allocate both central and embedded resources based on that as well.”

Infrastructure doesn’t  refer only to processes or a data analytics framework. Gwynne stressed the importance of the people developing these programs. “The longer folks work within these alternative payment models, the more they understand the mechanisms, the more they understand benchmarking, attribution, and everything else,” he said. “What we've been able to do is take those skill sets, apply them across different contracts, across different populations, and really inform how we grow as a healthcare system. We're redesigning our service lines around oncology and cardiovascular care. We’re at the table helping design what that growth strategy looks like, through the lens of fee for service, but also now through the lens of value, and it's our people who have those skill sets that are helping with those conversations.”

Sponsored Recommendations

Shield your health system against cyber threats

You won't want to miss out on this imperative April 4th webinar about how you can protect your healthcare organization. Join us to learn how to fortify your health system against...

Healthcare Trends 2024: Trends & Strategies for Future Success

Explore the future of healthcare in 2024 with insights from the Healthcare Industry Trends Report. Stay ahead of the curve as we delve into the latest industry developments and...

Trailblazing Technologies: Looking at the Top Technologies for the Emerging U.S. Healthcare System

Register for the first session of the Healthcare Innovation Spotlight Series today to learn more about 'Healthcare's New Promise: Generative AI', the latest technology that is...

Data: The Bedrock of Digital Engagement

Join us on March 21st to discover how data serves as the cornerstone of digital engagement in healthcare. Learn from Frederick Health's transformative journey and gain practical...