CCHC: ACO Pioneers in Eastern NC Health Care

This feature is part of an on-going series of features on accountable care organizations in North Carolina as part of the Toward Accountable Care (TAC) Consortium and Initiative.

It’s not easy becoming an Accountable Care Organization (ACO), but at least one fledgling North Carolina ACO, believed “it was the right thing to do for our patients.”

When Coastal Carolina Health Care, P.A. (CCHC) in New Bern was considering forming an ACO, they thought, “should we do it now, or wait?  There was a lot of debate around this topic,” said Stephen Nuckolls, Coastal Carolina’s CEO. “We felt that the program, while not perfect, was good enough at this point in time.  If we started early we could gain from our experience.  Also, there was a certain amount of fear that if we waited we’d lose a valuable learning experience.”

CCHC is based in New Bern and is comprised of 50-plus providers with 60 percent specializing in primary care.  They operate out of 11 locations and their other specialties include cardiology, gastroenterology, pulmonary/critical care, hematology/oncology, and neurology. They have an integrated electronic health record (EHR) system and all of their clinicians have met the requirements to be deemed “meaningful users”.  CCHC launched its ACO, Coastal Carolina Quality Care, Inc. last year and was accepted by The Centers for Medicare and Medicaid Services (CMS) in their first round with an April 1st start date and was one of five ACO’s nationwide to be accepted in this round into their Advance Payment Model.  This model allows for advance payments from CMS’s Innovation Center to fund start-up costs. 

Getting the doctors to buy into this model was the first and perhaps biggest hurdle to clear.  “Commitment from the physicians is vital,” Nuckolls said. The process involved first educating the group’s leadership on the concept. They discussed it in depth at their annual retreat; and the physician and administrative leaderhip team went to  a CMS sponsored Advance Development Learning Session (ADLS) where they heard from former CMS Secretary Don Berwick, a major impetus behind the agency’s support of such a model.  CCHC’s leaders felt that CMS was committed to the program and were confident they could be successful in achieving its goals.

While there are multiple keys to operating a successful ACO, Nuckolls is convinced that the first thing that needs to happen is physician engagement in the process. “It helps change the whole culture…and helps make the care transformation needed to have a successful ACO.”

Part of that transformation for CCHC has included hiring 10 care managers to help coordinate patients’ care, a nurse navigator and working with local transportation providers to help patients without transportation get to their appointments. Nurse triage lines were made available 24/7, Urgent Care clinic hours have expanded, and more next day appointments are now offered.  Increased marketing has helped patients become more aware of this enhanced access to care.

“The strategies CCHC focused on early were expanding access to patients since it would really help provide better patient satisfaction and help reduce costs,” Nuckolls said. “This model has been wonderful for our patients; especially the most fragile and those who have the greatest need for care.”

One of the ACO’s activities involves  a frequent and detailed physician review of all emergency room and hospital admissions of CCHC’s attributed beneficiaries with the goal  to uncover trends and opportunities to be more patient centered and cost effective.

Since implementing these changes, the practice has seen an increase in office visits by ACO beneficiaries, especially at its urgent care clinic, and a meaningful decrease in the number of emergency department visits and hospital admissions. 

In order to close gaps in care and help improve certain quality measures, the group also implemented a point-of-care electronic dashboard and a more robust clinical reporting system.  The dashboard allows doctors and their staff to better track and coordinate their patients’ care, while the clinical reporting system allows the group to better monitor its clinical quality measures.

Kenneth Wilkins, MD, an internist and president of CCHC, said he has made the transition and uses his patient “dashboard” with every patient. “It’s hard to change – to really convince us it’s worthwhile,” he said, but he is becoming increasingly sure the transformation to an ACO is indeed worthwhile for patients as well as doctors.


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