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ACOs managed by primary care practices greatly outperformed those managed by large hospitals or health systems in terms of savings, a panelist said. Primary care practices need time to adjust to managing patients differently when they transition to the ACO model. For instance, practices can break their reliance on fee-for-service office visits if they receive a monthly payment for each patient, said Coffey, citing the Comprehensive Primary Care Plus model launched by CMS this year as the most promising example. “You don’t want to make 25 people come into the office if you don’t have to,” he said. “(But) if they come into the office, you can charge $100, or you can do it over the phone for free. some basic advice on swift methods in med school interview prepBut if you have a (prospective) payment you can count on, then you can slow down the hamster wheel.” Farzad Mostashari, M.D., M.P.H., CEO of Bethesda, Md.-based Aledade, which helped launch 15 ACOs that include 1,000 primary care physicians and 200,000 patients, said that even the most efficient primary care practices need time to adjust to managing patients differently when they transition to the ACO model. Among other changes, they have to keep open slots in the appointment calendar for patients who need care immediately and offer some kind of triage on evenings and weekends. Also, primary care practices should call their patients who have been discharged from the hospital as soon as possible to reduce readmissions, said Mostashari. Practices affiliated with Aledade reduced ER visits by 10 percent and hospital readmissions by 15 percent.

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