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Spencer Berthelsen Kelsey-Seybold Medical Clinic
Berthelsen

Accountable care is 'future of healthcare,' chair of first NCQA-accredited ACO says


By Andis Robeznieks
Posted: December 14, 2012 - 11:45 am ET
Tags:

One of Kelsey-Seybold Medical Clinic's leaders is speaking out about the clinic's new distinction as the first accountable care organization to be accredited by the National Committee for Quality Assurance.

"It was kind of an exciting moment," said Dr. Spencer Berthelsen, chairman and managing director of the Houston-based clinic's board of managers, referring to NCQA President Margaret O'Kane's accreditation announcement Thursday. He added: "We believe accountable care is the future of healthcare."

The accreditation is based on the NCQA's evaluation of Kelsey-Seybold's ability to deliver coordinated, patient-centered care while improving quality, reducing costs and enhancing the patient experience, according to a news release. The assessment focused on characteristics such as structure and operations; access to providers; patient rights and responsibilities; and performance reporting. Six organizations applied for accreditation after the NCQA started accepting submissions in March of this year; Kelsey-Seybold was the first to receive it.

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Berthelsen said he viewed the accreditation as validation of the physician-owned clinic's efforts over the past decade to build a "culture of value" marked by improved quality and removal of unnecessary costs from its system of care.

Berthelsen noted that, according to the AON Hewitt Health Value Initiative, Kelsey-Seybold has reduced costs by as much as 20% compared with other organizations and that KelseyCare Advantage, the Medicare Advantage plan owned by the group, has earned a 4.5-star rating under the CMS five-star Medicare Advantage plan rating system.

On top of that, the Accreditation Association for Ambulatory Health Care has accredited the clinic and the NCQA has recognized it as a patient-centered medical home. Berthelsen described medical homes as being a primary-care subset of an ACO, with ACOs being more comprehensive by including more specialty, inpatient and home-care elements.

Kelsey-Seybold is not participating in the Medicare shared-savings program for ACOs because it has already surpassed what that initiative is trying to accomplish, Berthelsen said.

"We believe (the shared-savings program is) an earlier phase in the movement" toward coordinated care, he explained.

Part of Kelsey-Seybold's movement in that direction has been the implementation of an electronic health-record system and the development of specialized facilities "designed to bring under one roof all the things the patient may need in the ambulatory setting," Berthelsen said. This includes a pharmacy and areas and equipment for imaging, biopsies, infusion treatment, endoscopy and ambulatory surgery. The clinic has 20 locations in all, with three so far having the comprehensive design Berthelsen described.

Despite its cost-reduction strategies, Berthelsen said the clinic sees few patients covered by the Texas Medicaid program because it simply can't afford to as reimbursement rates are "extraordinarily low and don't come close to covering costs."

According to the U.S. Census Bureau, Texas has the highest uninsured rate in the nation, at 24.6%—well above the national average of 16%.

"We know there is room for improvement," Berthelsen said of the country's healthcare system. "We need more tension applied to cost and quality of care."


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