How Pathologists Earned a Place at the ACO Table

How Pathologists Earned a Place at the ACO Table

ACO Table ALL ANATOMIC PATHOLOGISTS WONDERING ABOUT THEIR PLACE in a healthcare system dominated by accountable care organizations (ACOs) and similar models of integrated clinical care may find useful insights from the experience of a six-partner pathology group in Wisconsin as it established itself as a contributor in one of the state’s largest integrated care networks.

As you will read on pages 3-6 of this issue, pathologists at North Shore Pathologists in Milwaukee, did have a place at the table from the inception of what is now called the Integrated Health Network of Wisconsin back in 2012. In this network are 5,700 physicians and participating providers, 550 clinics, and 45 hospitals. It is estimated that this network serves three million lives.

In learning about the steps the North Shore Pathologists took to be part of the network from its early days, a key insight for me was the advance groundwork laid by these pathologists in preceding years. As you will learn from THE DARK REPORT’S exclusive interview with Guillermo Martinez-Torres, M.D., a partner and president of the pathology group, several years earlier, North Shore Pathologists had worked with hospital administrators to add specific clauses to their contract.

For example, as early as 10 years ago, the pathology group had added language to their hospital contract to address how outreach revenue would be allotted. According to Martinez-Torres, this was done in anticipation of future moves by the hospital to expand its outreach services.

Another shrewd strategy was to study bundled pricing as part of the pathology group’s strategic planning. A payment formula was developed that could be used if the pathologists were engaged in global billing with other entities outside of their parent health system.

It was Louis Pasteur who said that “Fortune favors the prepared mind.” As you will read in our intelligence briefing about North Shore Pathologists and their ongoing engagement with the Integrated Health Network of Wisconsin, it was the foresight and preparation of the group in years before the formation of this integrated care network that helped them convince the organizers that there was a useful role for pathologists. Now they contribute value through better utilization of lab testing and consultative support to clinicians that helps, the ACO’s providers deliver improved patient outcomes.

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