An ACO Success Story: Quality, Value and Shared Savings

With assistance and strategic guidance from FTI consulting, primary partners was formed in 2012 by two primary care providers and was successful in winning approval of two ACO applications and an advance start‐up funding loan from medicare.

The Advance payment loan from CMS helped Primary Partners build the infrastructure to move forward. Since then, Primary Partners has grown to 200 providers, been awarded the number one ACO quality score in Florida two years running and number four nationally. It has achieved more than $20 million in shared savings, established numerous partnerships with payers, hospitals and, the Florida Health Information Exchange (HIE) and developed a compassionate, scalable and data analytics approach. This approach supports its member providers in their desire to improve the quality of care, service and value.

"PP attributes a large part of our success in developing and achieving our strategy to our FTI lead Chuck Holt. We look forward to continuing to work with FTI as we support our providers in continuing to be industry leaders in the delivery of quality of care, service and value to the communities they serve." Robert Brownie, CEO, Primary Partners, Allie Torres, CFO/COO, Primary Partners, Memory Crowley, MD, and Cara Jacob, MD, Co‐CMOs, Primary Partners

This integrated group of high performing physicians dedicates itself to providing quality coordinated care, creating a positive patient experience and improved health outcomes, and reducing growth in healthcare expenditures. The company brings a voice to patients and independent providers and supports physicians in maintaining independent practices and balance of life. The organization is owned and operated by physicians and includes performance affiliations and linkages with payers, health systems, health data analytics firms and Florida’s health information data exchange.

Primary Partners’ approach, designed with assistance from FTI Consulting experts, includes a core team of providers, clinical care and administrative personnel who focus on preventive health and disease management and providing patients access to the right care at the right time and place. The firm is heavily focused on population health data analytics. It develops programs to improve health and care access at the population level, then drives this to the practice, provider and individual patient level. The group uses score cards and coaching. It shares best practices with providers, clinical and administrative teams in a caring and supportive manor. Another success factor is the core team’s ability to create, organize and simplify programs and information. This allows busy providers and their practice management teams to make faster and better interventions at the point of care, including phone, ambulatory, hospital and post‐acute care settings.

Paramount to the group’s growth has been its openness, transparency and steadfast focus on improving quality of care, service and value to the communities it serves. Key growth premises include returning the management and outcomes of healthcare to providers and their care teams and supporting these teams with data, analytics and new approaches to care delivery that improve outcomes and patient and provider satisfaction.

Coupled with this, Primary Partners’ core support team structure and management process allow it to scale with growth while maintaining quality assurance of service delivery. These core teams evaluate practice and provider gaps in readiness to join an outcomes, value and continuous improvement model. They then design and implement customized change management action plans in collaboration with the practice and providers to close the gaps. These plans include participating practices’ workforce awareness, engagement and development and embedment of efficient operational processes and the progress metrics required to transform and sustain an outcome and value‐based model.

The planning and structures developed by Primary Partners and FTI Consulting have proven successful. In 2014, Primary Partners secured a Cigna shared‐savings contract. By 2016, Primary Partners had achieved top performance recognition in quality care delivery with 100 participating providers. Moving into a growth phase, the group created the scale necessary to take on risk agreements, mitigate the impact of any one risk and achieve higher levels of success. As of the end of 2017, the number of participating providers had grown to 200. The group achieved a number one quality performance ranking for two consecutive years in Florida and number four nationally. Medicare and Cigna ACO payer contract performance and shared savings award distributions of more than $20 million have allowed repayment of the CMS advanced funding loan, incentive distributions to participating practices and their providers and funding for the next phase of primary care growth in quality, value and scale. In 2017, Primary Partners added Florida Blue payer agreements and two direct‐toemployer agreements with the Disney Company through two affiliated hospitals; the company is also continuing discussions focused on diversifying payer contracts, services and affiliations. The group is on track to grow to 500 providers, 300,000 covered lives and $1.8 billion of managed premiums within the next five years, as like‐minded physicians join its ranks of providers delivering high quality care, service and value.

Impact: FTI Consulting Involvement

Primary Partners’ leadership continues to leverage FTI Consulting as its advisor. FTI Consulting’s role includes:

Strategy and implementation advisor to the senior executive team and board
Participant and advisor in regular bi‐weekly senior leadership meetings
Quality of care, service and value program identification, development and execution
Ongoing lead role in discussion and recommendations related: senior leadership development and recruitment, governance and ownership, negotiations and contracting for acquisitions, partnerships, mergers and affiliations with providers, payers, health systems; vendor contracting such as population health analytics platforms; and network development
Financial advisor for financial performance management, forecasting, risk contracting, financing, profit distributions and reserve management