By Betty Hintch

A budding ACO in Arizona is identifying some key approaches to building successful partnerships and managing patients across the continuum. 

Arizona Connected Care?which brings together Tucson Medical Center, local physicians, and three federally qualified health centers?is leading the way in developing new provider models championed by the Affordable Care Act (ACA). The law's intent is to offer hospitals and other providers a structural model, known as accountable care organizations (ACOs), to control costs while improving quality.

Savings that result from ACO arrangements in U.S. hospitals could be as high as $45 billion per year for all dual-eligible patients who qualify for Medicaid and Medicare benefits, said Elliott Fisher, MD, MPH, during a September Institute for Healthcare Improvement (IHI) webcast, "Pioneering ACOs: What Do We Know So Far?" Fisher is director, Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice, and a pioneer in the ACO concept.

Arizona Connected Care is one of approximately 250 healthcare groups in the United States to qualify as ACOs, said Fisher. About 150 of these are federally sponsored ACOs under the Medicare Shared Savings Program or the Advance Payment ACO Program. The rest are private ACOs, which have more flexibility in how they form and operate than their public counterparts.

Tucson Strategies

During the IHI webcast, two executives from Arizona Connected Care shared tips for ACO development:

Include public and private payers. Arizona Connected Care is in the Medicare Shared Savings Program and has taken on commercial contracts from United Healthcare and is entertaining contract proposals from several other payers. The ACO is committed to providing the same high-quality care to all patients, whether they are covered by Medicare or a commercial payer.

"We are trying to force change in the culture and in the provision of care," said John Friend, executive director, Arizona Connected Care. "ACOs represent systemic transformation. For that reason, you can't make deep improvements in care quality and efficiency if you are excluding certain payers and patients from the ACO model," Friend explains.

Promote provider participation. To date, more than 200 physicians are partnering with Arizona Connected Care. The ACO asks physician practices and other providers that want to join the organization to complete a series of evaluations and questionnaires that determine the health and sustainability of the organization. For instance, physicians must provide information on their resources and systems, such as electronic health records and adequacy of administrative and clinical staff, to enable care improvement initiatives and reporting. They must also demonstrate their commitment to adopt and administer best practices and to improve based on comparative data. 

"We sit down with those potential ACO partners to assess the quality of their services and the potential for improvement," said Pal Evans, MD, former senior vice president and chief medical officer, Tucson Medical Center. In many cases, these providers don't always have reliable data on patient outcomes and the delivery of quality care, which presents a challenge. At the same time, Evans notes that those providers are some of the most rewarding to work with because they tend to realize the most savings and improvements in quality and efficiency when they join the ACO.

Establish patient engagement initiatives. Tucson Medical Center's patient engagement committee developed Volunteer U, a program that trains healthy older adults within the local Medicare beneficiary pool to serve as patient advocates and offer support and education to peers who are transitioning from a hospital stay. "We recruited local seniors who were retiring from successful careers but weren't ready to stop contributing to the community. They run support groups and identify discharged patients who may need additional help managing their illnesses," says Friend.

Tucson Medical Center has taken its peer advocate program further by training about 10 seniors to be care coaches. By early 2013, those coaches will have the knowledge to evaluate whether a patient is transitioning smoothly after discharge and to recommend additional care resources when necessary," Friend explains.

In addition to contributing to lower readmission rates and improving the quality of life for senior patients, these senior volunteers act as community ambassadors for Arizona Connected Care. They demonstrate the ACO's concern for the well being of its patients.  

Patient Care Breakthrough

Through its ACO, Arizona Connected Care is hoping to redefine the healthcare marketplace and encourage more collaboration among providers to improve patient care. "It was a breakthrough moment when we came to conclude as a group that we could really improve patient care," says Friend in a recent interview in Leadership magazine. "Many initially said, 'This sounds like something I heard before, and none of this ever works.' But we are to the point now where there is a high degree of excitement around how we can use data and information and collaborate to actually improve outcomes for patients."

Betty Hintch is editor, newsletters and forums, at HFMA.

Quoted in this article (in order of appearance):
Elliott Fisher, MD, MPH, is director, Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, N.H. (

John Friend is vice president business development and associate general counsel, Tucson Medical Center Healthcare, and executive director, Arizona Connected Care LLC, Tucson, Ariz. (

Palmer Evans, MD, is former senior vice president and chief medical officer, Tucson Medical Center, Tucson, Ariz.

Portions of this article are based on information provided during "Pioneering ACOs: What Do We Know So Far?" a WIHI webcast presented in September 2012 by the Institute for Healthcare Improvement.

For more information on Arizona Connected Care, read "An Arizona Collaborative Shares in the Savings," published in the Fall-Winter 2012 issue of Leadership magazine. 



Publication Date: Friday, December 14, 2012