Case Study Demonstrates Benefits of a Primary Care-based Accountable Care Organization

Thursday, January 06, 2011


A San Antonio accountable care organization with a network of patient-centered medical home clinics but no hospital is providing comprehensive, high quality and efficient health care services that improve patient care and outcomes.

That's a conclusion to be drawn from “Case Study of a Primary Care-Based Accountable Care System Approach to Medical Home Transformation,” a study by Robert Phillips, Jr., MD, MSPH, director of the Robert Graham Center for Policy Studies, and his coauthors. The article was published this week by the Journal of Ambulatory Care Management.

“This shows that primary care physicians can organize to develop their own accountable care system,” said Phillips of the study. Small and solo physicians can participate in ACOs by affiliating with one another under an organizational structure that incorporates ACO functions. “Being part of an organization in some form is needed to get this level of care.”

Phillips and his colleagues looked at the organization and services provided between 2000 and 2008 by WellMed Medical Group, which has more than 87,000 patients and plan members. The researchers focused on Medicare Advantage patients, many of whom have complex health conditions such as diabetes, congestive heart failure, ischemic heart disease, chronic obstructive pulmonary disease and asthma, who were receiving care at 21 WellMed Group practices in San Antonio.

Over the past 20 years, WellMed has developed a care model that meets 97 of the 100 elements that define a patient-centered medical home, according to the National Committee for Quality Assurance guidelines. It also has well-developed disease and complex care management programs, health coaches, and close monitoring of quality.

Each patient has a primary care physician who provides diagnosis, treatment, referral to subspecialists and coordination of all care. Each physician cares for fewer than 500 patients, on average, and works with nurse practitioners, physician assistants, health coaches and social services workers. The clinic provides an on-site pharmacy, dental and vision services, hearing aid benefits, nutritional counseling and transportation assistance.

An electronic data monitoring system tracks the preventive care provided, current status and outcomes of care for each patient; helps WellMed develop interventions when it identifies a trend in less-than-adequate outcomes; and regularly reports quality measures on patients to both clinics and individual physicians in the network. The company also reviews subspecialists’ and hospitals’ outcomes, and bases referrals on that information.

In addition, each patient has a portable device that provides secure online access to their medical records. The device also ensures that subspecialist physicians and hospital, nursing home or home care agency staff have the most current information about their patients.

During the case study, Phillips and his colleagues found that although the clinics cared for older patients and more men than is typical for Medicare, “WellMed improved preventive care for the conditions that we measured and achieved remarkably high guideline compliance for diabetes and blood pressure. Their mortality rates remain well below the state average.”

The case study demonstrates that a primary care physician-based ACO is not only viable, but also very effective in providing high quality and efficient care, according to Phillips.

“You can get much better outcomes” with such a PCMH-based ACO over the current health delivery system, he said. “Their preventive measures are better and the mortality was half that for people of the same gender and age” statewide in Texas.

# # #

Founded in 1947, the American Academy of Family Physicians represents 136,700 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

To learn more about the AAFP and family medicine, visit Follow us on Twitter,( and like us on Facebook. For information about health care, health conditions and wellness, visit the AAFP’s award-winning consumer website,