FLORIDA ACCOUNTABLE CARE SERVICES (FACS)—BRIEF HISTORY AND MISSION

Since its inception in 2010, Florida Accountable Care Services (FACS) has been unwaveringly committed to the mission of building a diversified foundation to support and preserve the independence of community-based physicians and to positively impact the delivery and outcomes of healthcare. This mission has evolved coincident with what is now frequently referred to as a complete “paradigm shift” in healthcare from volume-based care to value-based and risk-based care.  The leadership team of FACS, guided from its beginning by Dr. Sandeep Bajaj, realized in advance of the innovations fostered by the Affordable Care Act, (e.g., Medicare Shared Savings Program and the advent of Accountable Care Organizations), and more recently, the Quality Payment Program (QPP) and associated Merit-Based Incentive Payment System (MIPS), and Advanced Payment Models (APMs) created by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), that for physicians (and equally important their office staff) to remain independent and survive  in the emerging value-based/risk-based healthcare environment, they must be willing to:

  • Pull the plug on old operating models and earnestly embrace the new value-based order of the business of medicine that aligns payment to providers based on the quality of care delivered, rather than the quantity of care they give patients.
  • Fully acknowledge and accept the challenges and opportunities granted by the contemporary healthcare environment for reinventing healthcare through active and sustained participation in physician led Accountable Care Organizations (ACOs).
  • Engage in steadfast adherence to a moral compass that is firmly directed at fostering improved patient experience of care, improved health of populations, and reduced per capita cost of health care.
  • Commit to actionable and compliant engagement with a robust health information technology platform that facilitates interoperability and effective clinical integration, care coordination, and comprehensive care management.
  • Accept and accommodate the importance of continuous promotion of transparency and accountability in the provision of health services to populations.
  • Accept and accommodate the important interface between the intent of value-based care and systematically measuring, tracking, and improving outcome performance utilizing widely recognized reliable and valid performance measures and methodologies (e.g., HEDIS; CAHPS).

In 2011, Senior Executives of FACS, armed with endorsements from the Florida Medical Association and the Florida Osteopathic Medicine Association, implemented a broad based educational campaign to educate physicians throughout the State of Florida on 1) the emerging shift in traditional volume-based fee-for-service care toward value based care, 2) the implications of the shift for community practices and the changes are likely required to maintain independence and solvency, and 3) the formidable role the new concept of Accountable Care Organizations (ACOs) may play in the transformation.  With the  groundwork laid in the physician community, FACS committed to involvement in the new CMS Medicare Shared Savings Program (MSSP) with the implementation in 2012 of one of the first of 27 MSSP ACOs in the country—Florida Physicians Trust (FPT), and one of two in the State of Florida.  The initial target for FPT was the counties representing the greater Orlando, Florida geographic area.

With feet barely wet from FPT, FACS soon implemented a second MSSP ACO in January of 2013—Central Florida Physicians Trust (CFPT).  Both FPT and CFPT have and continue to yield consistent successes, with combined net savings to the Medicare Program in excess of eighty million dollars ($83,000,000.00) from during the period 2013 to 2018 and a ranking annually in the top 8% to 3% of MSSP ACOs nationally. (See the FACS Success Portal of the website for details on the cumulative savings and national ranking for FPT and CFPT under the CMS MSSP).

The early and sustained success of FPT and CFPT not only captured the attention of key leaders in the CMS Innovations Center, but as well significant players in the commercial health insurance industry.  In 2016, FACS established with Cigna a commercial ACO in Central Florida, soon followed by a commercial  agreement with United Healthcare for their first commercial ACO in Florida.   The adventure into the commercial ACO arena has proven successful for both the payors and FACS, with consistent saving and enhanced quality performance realized as a function of time.

Under the new MSSP “Pathways to Success” Initiative, FACS will premier in January of 2020, a third Medicare Shared Saving Program ACO—America’s ACO, expanding the footprint of FACS ACOs to thirteen (13) Florida counties, with a network of over 300 primary care providers providing quality care and service to in excess of 80,000 commercial and Medicare lives.  FPT and CFPT are risk-based Basic Track—Level E MSSP ACOs, with America’s ACO leaving the gate as a Basic Track non-risk bearing Level A MSSP ACO.

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