Provider flips ACO model

Friday, August 8, 2014

WESTMINSTER, Md. – HME provider Randy Weston wants to break the mold of the traditional accountable care organization (ACO) model.

Although most models are physician or hospital based, he is developing an ACO based on ancillary services, such as HME, pharmacy, nursing and lab testing. The ACO, called Valley ACO, was recently approved by Medicare.

“We think by flipping it upside down we will be successful and more flexible,” said Weston, CEO of Mobility Rehabilitation Products and The Weston Group.

The Affordable Care Act of 2010 called for a reduction in hospital readmissions for Medicare beneficiaries. That includes the formation of ACOs, in which healthcare providers work together to provide high quality, coordinated care.

Valley ACO’s next step: attracting a network of participants, including physician and hospital groups. So far, feedback has been positive, says Weston.

“The physicians get to participate in the ACO and share in some of the possible revenue savings, which is nice, and they still own their practice,” he said. “They also get access to other potential referral sources.”

Forming an ACO isn’t all that much of a stretch for Weston, whose portfolio of healthcare businesses covers assisted living, skilled nursing, nursing, hospice, pharmacy and lab, in addition to DME. Looking to the long term, Weston envisions a very streamlined healthcare model.

“We’d like to design an electronic medical records system that will include all the ancillary participants and offer everybody (access to) that system,” said Weston. “If a therapist gets a referral from a physician, I don’t have to fax him six times or do a lot of the stuff we have to do now in the DME world.”

Although Weston’s model is the exception rather than the rule, it’s an avenue worth pursuing, says consultant Greg Shockey. Post-acute care providers offer valuable experience with the target patient populations, he says.

“Most of these big ACOs are focusing on the 5% of patients that are responsible for 50% of hospital charges,” said Shockey, managing member of Accountable Care Expos. “For post-acute care providers, that’s nearly all of their patients. The bottom line is, you have to do something different.”