I had an epiphany one day back in 1995. It was not my first, nor, hopefully, will it be my last. Nonetheless, it was an “ah-ha” moment in my evolution as a physician. I woke up one morning and said, “I’m mad as hell and I’m not going to take it anymore.” While this was by no means an original line (Network, 1976), it accurately reflected what I’d been pondering for a while.   We can create a better healthcare system. We can create better value for our community and our patients. And the first step is stop whining and do something!  That’s how it all began ¾ we founded Crystal Run Healthcare as a Physician Partnership on January 1, 1996.  Little did I know at the time that we’d be “living the dream” little more than 10 years later as a successful Accountable Care Organization.

Ahead of the curve as an “Early Adopter”    As an early adopter of the NextGen® Ambulatory EHR platform, we had one of the first fully implemented electronic health records systems in the country in a multi-specialty group practice. We became the first medical private practice in the state of New York to be accredited by the Joint Commission and were among the early level-3, patient-centered medical homes in the country.  And, most recently, we became the first nationally accredited, (NCQA) Accountable Care organization in the state of New York and one of the first six in the United States.

We don’t want to get paid for “healthcare;” we want to get paid for “health”   As physicians, we are deeply committed to our patients—as I often point out to hospital administrators and health insurance company executives—we are the only ones at the health care “table” who swore an oath to act in the best interests of those for whom we provide care.  .At the same time, we earn our living from the practice of medicine—and Crystal Run Healthcare is a for-profit entity. Putting patients first and being successful as a business are concepts which are by no means at odds with one another.  The key is redefining our “product” or service—from the provision of heathcare services—colonoscopy, chemotherapy, surgery, office visits—to the achievement of better health outcomes.  The United States healthcare system is fragmented and inefficient and care quality and delivery can be greatly improved.  For too long, physicians have been acting like little more than procedure salespeople, dealing in transactions, rather than acting as the stewards of patient care, dealing in outcomes.  At Crystal Run we are transitioning from a transaction-based fee-for-service system to an outcomes-based, fee-for-value compensation system. We want to be financially rewarded for health, not healthcare.   As a result, we are healthcare agnostics—we are not incented to do too much or too little—just to do right for our patients.    We are passionate believers in the Triple Aim—better care, better health, and lower cost—and our early results suggest we are well on our way to accomplishing our goals.

Decreasing healthcare costs by over 13%   While we don’t have our definitive results yet from CMS, our early results indicate that since we went live with our Medicare Shared Savings Program, we have decreased per-member, per-month costs of healthcare by over 13%.

Data-driven Outcomes   An ACO is a value-driven, analytics-enabled, patient-centered organization which includes one or more providers who are collectively accountable for outcomes.  We must accept risk for quality, cost, and our population of patients. An ACO must seek to achieve the triple aim of better care, better health, and lower costs.  Providers or owners in an ACO are at risk because they can’t simply lower the cost of care. They must provide better care by standardizing care quality based on best practices, evidence-based medicine, and patient empowerment. If they don’t do that, the quality gates and other thresholds that are embodied in the ACO system will lead to lower payments or no payments.

Collaboration and Innovation– the recipe for ACO success    Crystal Run is executing upon innovation as a key driver of our continued success where the best ideas from our staff will be implemented and funded by the organization. In the long run, physicians can do this by working together to share ideas and develop their own best practices instead of being instructed by external entities how to provide the best care.