May 17, 2024
Samuel “Le” Church, MD, a family physician with 20+ years of experience in rural Georgia, is no stranger to the limitations of the traditional fee-for-service model. While managing Synergy Health, one of the region’s largest primary care practices, he navigated the challenges of the time-intensive Merit-based Incentive Payment System (MIPS), which rewards eligible clinicians for providing high-quality, efficient care within the fee-for-service model.
“We were climbing the ladder of success,” Dr. Church said. “Unfortunately, the ladder was on the wrong wall.”
In 2020, amidst the COVID-19 pandemic, Dr. Church made the pivotal decision to join an Aledade ACO. The practice conducted its onboarding virtually, beginning its journey in a regional ACO, where it was able to overcome some operational hurdles and initial staff resistance.
“Your first year in an Aledade ACO is a training period,” said Andrew Chang, Market President. “It’s really where you learn to improve your workflows and get more efficient before taking on more risk.”
The following year, now an engaged, high-performing practice, Synergy joined local peers in Aledade’s Georgia ACO, participating in the Medicare Shared Savings Program’s Enhanced track, which allows practices to take on more risk and keep a greater share of any savings they generate.
Collaboration in crisis
However, the practice faced a significant hurdle when in Aledade’s 2023 review of the ACO roster, it came to light that Synergy Health had been deactivated as a Medicare provider. The sudden status change, caused by an administrative oversight by CMS, threatened not only the practice’s ability to provide care to Medicare patients but also the viability of the practice and its affiliation with the ACO.
“Medicare is our largest insurer. That would have devastated my practice and had a significant impact on our community,” said Dr. Church.
Upon making this discovery, the Aledade team immediately sprung into action. The ACO’s market manager compiled all previously submitted paperwork from the practice and served as the go-between for the office and the Centers for Medicare & Medicaid Services. Thanks to quick and coordinated efforts, including the involvement of Aledade’s policy leaders, the issue was resolved and the practice’s status as a Medicare provider was reinstated.
“I’m just incredibly thankful for these folks who eat, sleep and breathe policy, or we would have been kicked out of our ACO for next year. Had that not gotten fixed when it did, I would still be out of practice right now because that does not get undone very easily.”
– Dr. Samuel Church
‘Something different’ for patients
Today, Dr. Church serves as a local medical director for fellow clinicians learning how to integrate value-based care into their workflows. He worked with Synergy Health’s quality team to devise innovative solutions to bridge the gap between former processes and current best practices. For example, the practice has introduced a custom stamp that can be applied to the Aledade App’s Daily Huddle sheet, allowing staff members to add key clinical details and personalize patient interactions while remaining efficient.
Synergy Health has also benefitted from patient outreach efforts Aledade conducts on behalf of its ACO member practices. This includes the Healthy for the Holidays campaign, which aims to keep patients out of the hospital and emergency department in the fourth quarter of the year.
“My patients know that Aledade is around, and they know there’s something different,” Dr. Church said. “For example, the Healthy for the Holidays notifications and direct mail campaigns – it just wasn’t possible to pull off that kind of effort and prioritize these communications as a small practice.”
Shortly after its reinstatement as a Medicare provider, Synergy Health learned that its ACO was Georgia’s top performer in the 2022 Medicare Shared Savings Program. But it’s not only Medicare patients who are benefitting. Synergy Health now actively participates in eight value-based care contracts with Aledade, including several with Medicare Advantage and commercial insurers, covering the majority of its patient panel.
Across this population, the team has achieved an impressive 90% completion rate for annual wellness visits, 93% emergency department follow-up rate and 80% blood pressure control. According to Dr. Church, this type of progress would not have been possible in the fee-for-service model.
“Had it not been for Aledade, I’d be with one of the competing groups. I’ve talked to a lot of docs who are recovering from their experiences with other ACOs. They are not as positive – some are, but many have struggled,” Dr. Church said. “I’m thankful to have landed in the Aledade camp.”