University of michigan case study: The physician group practice demonstration

Abstract

A fundamental question in health policy is how the newly forming Accountable Care Organizations (ACO) will achieve high quality and efficient care for patients and populations. ACO’s have been operating for about 2 years and information is beginning to be released about their performance. However, there is several years of information from an important precursor to Medicare ACO’s the Physician Group Practice Demonstration (PGPD)2. The University of Michigan (UM) was one of 10 large physician organizations that participated in the PGPD from 2005’2010, and achieved shared savings and high quality for all 5 years. UM is an integrated academic healthcare system with experience in managed care clinical and governance integration and a unified EMR. For the PGPD, UM implemented numerous transitional care and care coordination activities. UM system characteristics and interventions were probably all important in bending the curve. In addition, attribution of sicker patients by attribution to the multispecialty group instead of just primary care physicians, the presence of skilled specialists and generalists who are comfortable caring for sick patients, and employed faculty physicians who are comfortable with an academic mission, may also have contributed. Future information about the performance of the many different types of healthcare systems participating in the ACO programs may very well point to many different healthcare system configurations, including Academic Healthcare Systems, which can achieve high quality and efficient patient care.