– Physician networks are key to the success of accountable care organizations. Leaders of these organizations, otherwise known as ACOs, lean on their networks of high-quality, cost-efficient providers to improve patient outcomes, reduce costs of care, and achieve shared savings.
But patients don’t always stay within cultivated high-performing networks, creating quality and cost problems for even the best ACOs.
“Historically, we were seeing only roughly about 42 percent of the services from our population coming in-network,” Tyler Munson, senior vice president of operations at Southwestern Health Resources, recently told RevCycleIntelligence.
Flipping that statistic around, Munson said that means a majority of patients treated by the Texas-based clinically integrated network and its ACO providers were receiving out-of-network care.
SWHR’s ACO is one of the nation’s top-performing Next Generation ACOs. Its Southwestern Health Resources Accountable Care Network saved more than $52 million in 2019, accounting for a fifth of total program savings that year and bringing its individual ACO savings to $120 million since joining the program in 2017.