WEBVTT
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Welcome to Pack and Forth, the official podcast of the Physician Association of California.
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We're here to protect the future of private practice.
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This show is for independent physicians, policymakers, and patients.
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Let's dive in.
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Today we're joined by Tyler Trasewski, president of Astrana Care Partners ACO.
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Tyler leads Astrana's accountable care efforts, working with physicians across California to navigate the shift toward value-based care.
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We're also announcing a new development.
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PAC has announced a collaboration with Astrana Health to support independent primary care physicians with care coordination, population health tools, and ACO participation.
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In today's conversation, we'll cover how this model works and what it could look like for you and your patients.
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Tyler, welcome to PAC and Forth.
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Thank you.
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So I want to start with the basics.
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What exactly is an ACO, an accountable care organization?
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And then if you could tell us where Astrana fits into that universe of ACOs?
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Sure, it's a great question.
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At its simplest level, an accountable care organization or an ACO is really a voluntary network of healthcare providers.
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Usually they're predominantly primary care doctors, and they come together to coordinate care for a defined population of patients or in this case, Medicare beneficiaries.
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In this manner, they share a financial accountability and benefit and are responsible for the outcomes from a clinical and quality perspective for that population.
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In this context, the ACOs that we are talking about is those that are focused on the original Medicare or traditional Medicare piece of the population.
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ACO generally is a pretty broad term, and there are ACOs in the Medicaid space, in the commercial space, but for the purposes of this conversation, we're talking about traditional or original Medicare and Accountable Crowns that are developed and run by CMS and their counterparts at CMMI.
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The place that Astrana fits in to this model is we act as it can be called an enabler or an aggregator.
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We help to bring together independent primary care physicians to participate in these programs by providing wraparound services and support from a regulatory compliance programmatic perspective, as well as supporting physicians from a technology perspective, clinical perspective, and quality perspective.
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So, Tyler, can you explain a bit?
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Is that the same as an IPA or like how is this different than an IPA?
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Yep, it's a great question.
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This is different from an IPA because we are not doing any contracting of rates with insurance companies as part of these programs.
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The way that these programs are structured is that the ACO at large has a participant agreement or arrangement in place with CMS or CMMI, the governing body that operates the program.
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And then that ACO entity has participation agreements with each individual practice or array of providers that are participating in the ACO.
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We don't do any rate negotiation, we don't do any supply purchasing or group purchasing or things of that nature that might be occurring at an IPA.
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And it's it's really the linkage of participation in the ACO that we astrana in this context as an ACO enabler take care of.
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So let's get into the the economics.
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How does the shared savings model actually work?
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And can you walk us through how a physician generates revenue in this arrangement?
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What are they graded on?
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What should physicians know?
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Yep, absolutely.
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It's a it's a it's a great question.
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Um the the base model of how the economics of ACOs work is that we have this defined uh population of beneficiaries that I was talking about earlier.
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Um CMS uh creates what's called a benchmark, it's a risk-adjusted target or level of expected expenditure that it should take to take care of that entire population.
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That becomes, we should think about that as the revenue portion of the ACO model.
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Okay, for the determined period of time, typically a year, uh it is the job of the ACO to manage that population with the goal of bringing the actual expenditures below that benchmark or the risk risk-adjusted target, while at the same time being held accountable for uh various elements of quality to make sure that the outcomes from a beneficiary perspective clinically are uh solid or better than they were outside of this program.
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Okay, when and if those ex those actual expenditures are are brought in below the benchmark, savings are generated, right?
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And then programmatically, a portion of those savings is shared back with the ACO and a portion is retained by CMS or the government for the support of the trust fund, right?
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And so the the MSSP program, the Medicare Shared Savings Program, that's that's where that tie-in to shared savings comes from.
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It's the same mechanism, though there are nuances between the different types of programs that exist.
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From an individual provider perspective, um you know there are many different types of models that are out there across the country.
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At Astrana, um, we structure our agreements for our ACO participants in a in a transparent and straightforward way.
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In all of our programs, we provide upfront incentives to help practices invest in tools, staff, and workflows that help them to be successful in these programs, and to provide some of the savings that we expect them to generate or earn in these programs upfront rather than waiting many months until the program year comes to financial settlement, which is typically the summer following the actual year.
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So we we have a uh a mechanism for providing incentives, and then we share in any savings that are generated at the conclusion of the year with those providers, providing another avenue for uh enhanced revenue or a piece of that financial benefit from the program.
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I want to hear more about the savings, but first I'm curious about the inverse of that.
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If a physician does not meet the targets, how does that work?
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Do they lose money in this arrangement?
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Yep, great question.
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Um they can.
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It depends on their partnership and the arrangement that they have.
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Um at Astrana, Astrana bears all of the responsibility for downside risk.
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So we organizationally take that risk, we do not pass it on to the providers at all.
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So it really is a is a financial risk-free endeavor for providers with only financial upside, and a non-trivial amount of that is is actually guaranteed in the form of these upfront incentives that I was talking about.
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Great.
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So Tyre, so just just to clarify, what Impact is promoting with Ashana Health's ACO specifically, there is no risk for that provider becoming a part of uh of your network.
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Correct.
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Right.
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So let's let's let's talk about that a little bit because I mean surely if if a uh a primary care physician, independent practitioner, if they're interested, walk us through a little bit on like what is that process.
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I mean, do they just email you or like how does this work?
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Is there a is there a vetting process?
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Just explain a little bit to the listener and and to the provider like what this may look like on the back end.
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Absolutely.
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Yep.
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Um we have a robust process.
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Um we can talk about you know the how to how to get in touch with us through um you know inbound QR codes and appropriate contact information in in order to enter the process.
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Uh, but but generally the process starts with an actuarial evaluation.
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Um we have a an in-house actuarial team and we work with industry leaders such as Millman to forecast and model uh at a practice-specific level what their performance in various of our ACO programs is likely to look like in uh 2027 in this case, based on the program dynamics that we're talking about, how the benchmarks are created and structured, and historical claims experience that we're able to access.
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So we start with an actuarial process to first determine does this provider look like a good fit for any of our ACO programs, and if so, which one would we recommend placing them in?
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As we have we have multiple.
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Okay, it's through this process and that qualification element that we're able to do what I was just talking about, take the downside risk, offer upfront and guaranteed incentives, and have confidence that we're going to be able to do that sustainably, which is something I want to get to in another question.
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Umce we go through that actuarial process, um, you know, we we sort of make sure that we cover a few operational items.
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There are quality reporting requirements as part of these programs.
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Being on a certified electronic health record or a cert is an important aspect as the the nation kind of moves in in that direction.
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And there are a few other small boxes that we need to make sure are satisfied.
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Once that's okay, we move into contracting.
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And so we would move forward with a participant agreement between the ACO entity that's targeted and the provider themselves, get that contract locked up.
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That needs to occur during the summer months.
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There are key CMS deadlines that occur in August and September that we would be aiming against.
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And then as we get into Q4, contracting is done and we turn the page toward operational onboarding and implementation, where team uh would work individually with providers to provide training, provide implementation and onboarding support, and make sure that they're set up for success as we roll into the performance year starting January 1st.
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Great.
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So I have uh two follow-up questions.
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Uh one obviously very important.
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You know, our mission at PAC is to protect and enhance independent physicians.
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So, number one, if someone does enter and is approved through your uh ACO, do they remain independent physicians or are they employees of Ashana Health?
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And then also number two, how long does that process take for that interest?
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Let's say they reach out to you, they want to be a part of this, to then that ultimate approval and contracting process.
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Yep.
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So the first question is a very important one.
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The answer is a resounding yes, they remain independent, they remain all of their autonomy.
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Our goal is to provide access and support to the for these programs, but to not interrupt uh clinical workflows or or the autonomy or ownership of the practice at all.
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In fact, I I feel strongly that these programs and working and partnering with the Strana in this in this manner helps to protect the ability for providers to remain independent and solvent in that effort.
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Um, from a financial perspective, uh looking at 2024 as a as the indicator here, uh on average, providers that participated in an Astrana ACO supplemented their fee for service income by over 50% between upfront incentives and back-end shared savings.
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If we think about that on a PMPY or per member per year basis, the average number is around$375 above the fee schedule that they continue to receive from Medicare top performers more than doubled their fee for service income or generated over$700 more PMPY.
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So that financial benefit I think is really important for independent providers in their pursuit of remaining independent and being able to participate in this ever you know more complicated and complex regulatory environment that we have.
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From a timeline perspective, um I mentioned before we have key CMS-driven deadlines in these programs.
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Those are the first week of August and shortly after Labor Day in September.
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Um so those are the endpoints from a from a complete process perspective.
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It always varies depending on turnaround times and the ability to have meetings and that sort of thing.
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But it could happen in as little as a few weeks to go from the starting point, evaluation, discussions about contracting, getting it executed, and then moving forward on towards uh onboarding and implementation.
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Well, Tyler, these sound like great benefits uh for physicians who it works for.
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And I'm curious, I'd love to hear you talk about a strana's footprint in California and where it makes sense, what types of physicians, rural, urban, primary care, specialty, where does it work and where is it maybe not a good fit?
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Yep.
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Um it's a great, great question.
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Um overall uh Austrana's ACOs have a national footprint, literally with uh providers from Hawaii to Rhode Island.
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We have um over 600 individual uh practices, over 75,000 beneficiaries or patients under our umbrella operating across four ACO entities.
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Umstrana was was uh born in California, specifically Southern California.
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California remains our home state and our our most uh uh dense and largest region in the country and and um you know is our our highest concentration of providers.
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The providers that typically participate in these programs are primary care-focused providers, family practice, internal medicine, those types of specialties, because the attribution methodology of these ACO programs, meaning the patients that become part of the population that we're managing, are tied to primary care visits.
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So it's natural that the primary care specialty providers drive the attribution and are the, we can think about them as the quarterbacks for managing the this population.
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There are some tangential specialties that also have attribution sometimes.
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Think about cardiology, dermatology, things like that that find their way into the ACO.
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And specialists do play a very important role as they are participating in the care of the beneficiaries in a big way.
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Typically, however, specialists are don't become participants in these ACOs because of that attribution factor, though there are other types of contract arrangements that can be utilized when appropriate.
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But for clarity, for audience purposes, I would I would point towards primary care as the as the predominant specialty type that's applicable.
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And and uh Tyler, just want to make uh sure as well, if if a primary care physician that's part of the Shauna Health ACO they are still able to have other visits as well from patients with commercial health plans and so forth, or is this like an all or nothing thing?
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Absolutely.
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Yep.
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So um one of the great things about the ACO as distinct from Medicare Advantage or commercial is is the flexibility uh that that comes with it.
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Um because we're talking about the original or traditional Medicare population, you know, there there's no rate contracting like I talked about before, there's no network restrictions or requirements like is often the case with with Medicare Advantage or commercial insurance plans.
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Um, and providers have freedom and flexibility to choose the partner or the program that makes most sense for them.
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Um it is it is our goal uh at Astrana to develop and foster deep relationships with our provider partners and position ourselves to have contracts with a host of different payers so that we are able to kind of go deep with that provider and help support their care for patients, whether they have original Medicare and they're in an ACO program, whether they have MA and they could be with various MA payers, or they have commercial insurance, right?
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We we want to develop these deep relationships, um, create consistent workflows where providers are using the same tools to manage their entire population.
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And we think that that's one of the benefits that Astrana provides, especially in Cali in California, where we have uh deep penetration and density and contracts with lots of payers.
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Todd, let me ask you a couple more things too.
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And this is like in the kind of like the administrative burden space, which you and I have talked before, which you're very familiar with.
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I mean, administrative burdens, especially for our members, independent physicians, is a massive thing.
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Uh they don't have the staff, they don't have the resources to, you know, to deal with a lot of the other things that we were just talking about with you know, certain things with commercial payers, even the government, and so forth.
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So two things I have in mind that I want to ask you about is number one, what is it as such as with I guess you know, the prior authorization with these members that are within the ACO?
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What is that kind of approval percentage about?
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Like, is this are are they being denied for a lot of the treatment that they want to be able to provide to their patients?
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And then also two, if they are a part of this ACO, how much of a a new burden is put on them as far as reporting and so forth?
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And is that all on them, or does Ashrana Health help out with those wraparound services?
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Yep.
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Um in terms of prior off and approvals, the good thing about this ACO program is that their experience will be completely unchanged by participating in the ACO.
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Um CMS or the and the regional Mac continues to play that function for this original Medicare population.
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So the practice will continue to bill their Mac, the Mac will continue to play the role of authorization, they will be adjudicating claims, they will be making denial decisions.
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That role will not be impacted by the program at all.
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And further, the from a beneficiary perspective, their benefits won't be changed, their choices won't be changed or reduced.
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There's really no negative impacts from an authorization network service access perspective, either on the part of the provider or the beneficiary.
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So I think that's really important and a big difference between these original Medicare ACOs and maybe Medicare Advantage.
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Um in terms of burden at the practice level and some of the wraparound services.
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So that those questions and these issues are exactly why Astrana does what we do in this context to help enable these independent primary care providers and practices to participate in these programs.
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Um we handle the value that we add is by by making these programs accessible and not burdensome to participate in while they're able to benefit financially and clinically.
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To be more specific, we of course handle all of the the actual programmatic pieces of maintaining the ACO, all of the reporting, the actual work, contracting work, compliance, all of those things.
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The wraparound services that we provide, we feel at Astrana we have truly industry leading wraparound services.
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Um, technologically, um we have a custom in house AI driven platform that provides a host of capabilities for providers in the form.
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Of a provider portal that can help drive their workflow, raise patient lists, notify ADT notifications for when patients are in the hospital, provide insights on utilization and a host of other things.
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We also provide clinical and care management wraparound support services, not in a manner that is coming into the practice or changing a provider's workflow or anything like that.
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Things like when we know a patient's in a hospital trying to communicate and help to facilitate scheduling a follow-up visit.
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If a patient's in a hospital at an institution in California that we have a physical on-the-ground presence in, you can visit with that patient, help to facilitate transitional care services, make sure that they have a proper discharge plan and are in contact with their primary care provider to get seen after discharge.
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We also provide risk adjustment or coding as well as quality support services to help focus not only on outcomes and documentation, but also taking care of the reporting function as well.
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Tyler, you had signposted uh sustainability as a theme that you want to touch on.
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And I'm curious for a provider that enters into this relationship, how does that change after year two, year three, year five?
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What can providers look forward to?
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Yeah, um so we we are a proud astronaut and and specifically within the ACO program for conducting ourselves in a way that delivers sustainable results.
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Um from an astronaut perspective, the company overall we have over 20,000 physicians in in the network.
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Overall, we've we have a provider retention rate of over 98% and an average provider tenure of over 11 years.
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So globally at the astrona level, feel like that is a reflection of consistently delivering on the financial and operational commitments that we put forward.
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From an ACO perspective, um we've been in this business for a long time.
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Um and we're proud to say that we've delivered positive shared savings for 12 years in a row, looking to make uh 2026 number 13.
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Across those years, we've generated nearly a billion dollars in gross shared savings as part of these ACO programs.
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Um and we we do that by taking a pragmatic and sustainable approach uh to our qualification and our actuarial processes to make sure that yes, we're trying to grow, but we're doing so in a responsible way so that we're bringing partners into the ACO that belong there and that benefit the rest of the uh providers that are already here.
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That's great.
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So so, Tyler, just to wrap up on this, because I I mean PAC is obviously super excited about this collaboration uh to promote this opportunity.
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If a provider wants to learn more information, you know, directly from Ashrana Health, uh do they have a phone number they call?
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Do they they go to your website?
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Any information you can share about that?
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Yeah, great question.
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Um, we've been working with the team at PAC to create um customized and purposeful collateral and material about our ACO programs.
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We have a dedicated landing page uh within the Australia Health website uh for this purpose.
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I would I would recommend that folks refer to uh some of these links and materials that are being provided to all of the PAC members and being made available on the PAC's website as well as through various social channels in order to get connected with myself and team to explore the next steps.
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Great.
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Thank you so much, Tyler, for your time.
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Of course, thank you for having me.
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I greatly appreciate it.
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Welcome to Pack and Forth, the official podcast of the Physician Association of California.
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We're here to protect the future of private practice.
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This show is for independent physicians, policymakers, and patients.
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Let's dive in.
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Today we're joined by Tyler Trasewski, president of Astrana Care Partners ACO.
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Tyler leads Astrana's accountable care efforts, working with physicians across California to navigate the shift toward value-based care.
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We're also announcing a new development.
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PAC has announced a collaboration with Astrana Health to support independent primary care physicians with care coordination, population health tools, and ACO participation.
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In today's conversation, we'll cover how this model works and what it could look like for you and your patients.
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Tyler, welcome to PAC and Forth.
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Thank you.
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So I want to start with the basics.
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What exactly is an ACO, an accountable care organization?
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And then if you could tell us where Astrana fits into that universe of ACOs?
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Sure, it's a great question.
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At its simplest level, an accountable care organization or an ACO is really a voluntary network of healthcare providers.
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Usually they're predominantly primary care doctors, and they come together to coordinate care for a defined population of patients or in this case, Medicare beneficiaries.
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In this manner, they share a financial accountability and benefit and are responsible for the outcomes from a clinical and quality perspective for that population.
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In this context, the ACOs that we are talking about is those that are focused on the original Medicare or traditional Medicare piece of the population.
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ACO generally is a pretty broad term, and there are ACOs in the Medicaid space, in the commercial space, but for the purposes of this conversation, we're talking about traditional or original Medicare and Accountable Crowns that are developed and run by CMS and their counterparts at CMMI.
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The place that Astrana fits in to this model is we act as it can be called an enabler or an aggregator.
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We help to bring together independent primary care physicians to participate in these programs by providing wraparound services and support from a regulatory compliance programmatic perspective, as well as supporting physicians from a technology perspective, clinical perspective, and quality perspective.
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So, Tyler, can you explain a bit?
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Is that the same as an IPA or like how is this different than an IPA?
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Yep, it's a great question.
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This is different from an IPA because we are not doing any contracting of rates with insurance companies as part of these programs.
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The way that these programs are structured is that the ACO at large has a participant agreement or arrangement in place with CMS or CMMI, the governing body that operates the program.
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And then that ACO entity has participation agreements with each individual practice or array of providers that are participating in the ACO.
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We don't do any rate negotiation, we don't do any supply purchasing or group purchasing or things of that nature that might be occurring at an IPA.
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And it's it's really the linkage of participation in the ACO that we astrana in this context as an ACO enabler take care of.
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So let's get into the the economics.
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How does the shared savings model actually work?
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And can you walk us through how a physician generates revenue in this arrangement?
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What are they graded on?
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What should physicians know?
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Yep, absolutely.
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It's a it's a it's a great question.
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Um the the base model of how the economics of ACOs work is that we have this defined uh population of beneficiaries that I was talking about earlier.
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Um CMS uh creates what's called a benchmark, it's a risk-adjusted target or level of expected expenditure that it should take to take care of that entire population.
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That becomes, we should think about that as the revenue portion of the ACO model.
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Okay, for the determined period of time, typically a year, uh it is the job of the ACO to manage that population with the goal of bringing the actual expenditures below that benchmark or the risk risk-adjusted target, while at the same time being held accountable for uh various elements of quality to make sure that the outcomes from a beneficiary perspective clinically are uh solid or better than they were outside of this program.
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Okay, when and if those ex those actual expenditures are are brought in below the benchmark, savings are generated, right?
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And then programmatically, a portion of those savings is shared back with the ACO and a portion is retained by CMS or the government for the support of the trust fund, right?
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And so the the MSSP program, the Medicare Shared Savings Program, that's that's where that tie-in to shared savings comes from.
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It's the same mechanism, though there are nuances between the different types of programs that exist.
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From an individual provider perspective, um you know there are many different types of models that are out there across the country.
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At Astrana, um, we structure our agreements for our ACO participants in a in a transparent and straightforward way.
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In all of our programs, we provide upfront incentives to help practices invest in tools, staff, and workflows that help them to be successful in these programs, and to provide some of the savings that we expect them to generate or earn in these programs upfront rather than waiting many months until the program year comes to financial settlement, which is typically the summer following the actual year.
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So we we have a uh a mechanism for providing incentives, and then we share in any savings that are generated at the conclusion of the year with those providers, providing another avenue for uh enhanced revenue or a piece of that financial benefit from the program.
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I want to hear more about the savings, but first I'm curious about the inverse of that.
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If a physician does not meet the targets, how does that work?
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Do they lose money in this arrangement?
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Yep, great question.
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Um they can.
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It depends on their partnership and the arrangement that they have.
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Um at Astrana, Astrana bears all of the responsibility for downside risk.
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So we organizationally take that risk, we do not pass it on to the providers at all.
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So it really is a is a financial risk-free endeavor for providers with only financial upside, and a non-trivial amount of that is is actually guaranteed in the form of these upfront incentives that I was talking about.
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Great.
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So Tyre, so just just to clarify, what Impact is promoting with Ashana Health's ACO specifically, there is no risk for that provider becoming a part of uh of your network.
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Correct.
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Right.
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So let's let's let's talk about that a little bit because I mean surely if if a uh a primary care physician, independent practitioner, if they're interested, walk us through a little bit on like what is that process.
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I mean, do they just email you or like how does this work?
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Is there a is there a vetting process?
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Just explain a little bit to the listener and and to the provider like what this may look like on the back end.
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Absolutely.
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Yep.
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Um we have a robust process.
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Um we can talk about you know the how to how to get in touch with us through um you know inbound QR codes and appropriate contact information in in order to enter the process.
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Uh, but but generally the process starts with an actuarial evaluation.
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Um we have a an in-house actuarial team and we work with industry leaders such as Millman to forecast and model uh at a practice-specific level what their performance in various of our ACO programs is likely to look like in uh 2027 in this case, based on the program dynamics that we're talking about, how the benchmarks are created and structured, and historical claims experience that we're able to access.
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So we start with an actuarial process to first determine does this provider look like a good fit for any of our ACO programs, and if so, which one would we recommend placing them in?
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As we have we have multiple.
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Okay, it's through this process and that qualification element that we're able to do what I was just talking about, take the downside risk, offer upfront and guaranteed incentives, and have confidence that we're going to be able to do that sustainably, which is something I want to get to in another question.
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Umce we go through that actuarial process, um, you know, we we sort of make sure that we cover a few operational items.
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There are quality reporting requirements as part of these programs.
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Being on a certified electronic health record or a cert is an important aspect as the the nation kind of moves in in that direction.
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And there are a few other small boxes that we need to make sure are satisfied.
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Once that's okay, we move into contracting.
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And so we would move forward with a participant agreement between the ACO entity that's targeted and the provider themselves, get that contract locked up.
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That needs to occur during the summer months.
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There are key CMS deadlines that occur in August and September that we would be aiming against.
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And then as we get into Q4, contracting is done and we turn the page toward operational onboarding and implementation, where team uh would work individually with providers to provide training, provide implementation and onboarding support, and make sure that they're set up for success as we roll into the performance year starting January 1st.
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Great.
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So I have uh two follow-up questions.
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Uh one obviously very important.
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You know, our mission at PAC is to protect and enhance independent physicians.
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So, number one, if someone does enter and is approved through your uh ACO, do they remain independent physicians or are they employees of Ashana Health?
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And then also number two, how long does that process take for that interest?
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Let's say they reach out to you, they want to be a part of this, to then that ultimate approval and contracting process.
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Yep.
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So the first question is a very important one.
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The answer is a resounding yes, they remain independent, they remain all of their autonomy.
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Our goal is to provide access and support to the for these programs, but to not interrupt uh clinical workflows or or the autonomy or ownership of the practice at all.
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In fact, I I feel strongly that these programs and working and partnering with the Strana in this in this manner helps to protect the ability for providers to remain independent and solvent in that effort.
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Um, from a financial perspective, uh looking at 2024 as a as the indicator here, uh on average, providers that participated in an Astrana ACO supplemented their fee for service income by over 50% between upfront incentives and back-end shared savings.
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If we think about that on a PMPY or per member per year basis, the average number is around$375 above the fee schedule that they continue to receive from Medicare top performers more than doubled their fee for service income or generated over$700 more PMPY.
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So that financial benefit I think is really important for independent providers in their pursuit of remaining independent and being able to participate in this ever you know more complicated and complex regulatory environment that we have.
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From a timeline perspective, um I mentioned before we have key CMS-driven deadlines in these programs.
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Those are the first week of August and shortly after Labor Day in September.
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Um so those are the endpoints from a from a complete process perspective.
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It always varies depending on turnaround times and the ability to have meetings and that sort of thing.
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But it could happen in as little as a few weeks to go from the starting point, evaluation, discussions about contracting, getting it executed, and then moving forward on towards uh onboarding and implementation.
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Well, Tyler, these sound like great benefits uh for physicians who it works for.
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And I'm curious, I'd love to hear you talk about a strana's footprint in California and where it makes sense, what types of physicians, rural, urban, primary care, specialty, where does it work and where is it maybe not a good fit?
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Yep.
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Um it's a great, great question.
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Um overall uh Austrana's ACOs have a national footprint, literally with uh providers from Hawaii to Rhode Island.
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We have um over 600 individual uh practices, over 75,000 beneficiaries or patients under our umbrella operating across four ACO entities.
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Umstrana was was uh born in California, specifically Southern California.
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California remains our home state and our our most uh uh dense and largest region in the country and and um you know is our our highest concentration of providers.
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The providers that typically participate in these programs are primary care-focused providers, family practice, internal medicine, those types of specialties, because the attribution methodology of these ACO programs, meaning the patients that become part of the population that we're managing, are tied to primary care visits.
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So it's natural that the primary care specialty providers drive the attribution and are the, we can think about them as the quarterbacks for managing the this population.
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There are some tangential specialties that also have attribution sometimes.
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Think about cardiology, dermatology, things like that that find their way into the ACO.
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And specialists do play a very important role as they are participating in the care of the beneficiaries in a big way.
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Typically, however, specialists are don't become participants in these ACOs because of that attribution factor, though there are other types of contract arrangements that can be utilized when appropriate.
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But for clarity, for audience purposes, I would I would point towards primary care as the as the predominant specialty type that's applicable.
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And and uh Tyler, just want to make uh sure as well, if if a primary care physician that's part of the Shauna Health ACO they are still able to have other visits as well from patients with commercial health plans and so forth, or is this like an all or nothing thing?
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Absolutely.
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Yep.
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So um one of the great things about the ACO as distinct from Medicare Advantage or commercial is is the flexibility uh that that comes with it.
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Um because we're talking about the original or traditional Medicare population, you know, there there's no rate contracting like I talked about before, there's no network restrictions or requirements like is often the case with with Medicare Advantage or commercial insurance plans.
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Um, and providers have freedom and flexibility to choose the partner or the program that makes most sense for them.
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Um it is it is our goal uh at Astrana to develop and foster deep relationships with our provider partners and position ourselves to have contracts with a host of different payers so that we are able to kind of go deep with that provider and help support their care for patients, whether they have original Medicare and they're in an ACO program, whether they have MA and they could be with various MA payers, or they have commercial insurance, right?
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We we want to develop these deep relationships, um, create consistent workflows where providers are using the same tools to manage their entire population.
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And we think that that's one of the benefits that Astrana provides, especially in Cali in California, where we have uh deep penetration and density and contracts with lots of payers.
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Todd, let me ask you a couple more things too.
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And this is like in the kind of like the administrative burden space, which you and I have talked before, which you're very familiar with.
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I mean, administrative burdens, especially for our members, independent physicians, is a massive thing.
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Uh they don't have the staff, they don't have the resources to, you know, to deal with a lot of the other things that we were just talking about with you know, certain things with commercial payers, even the government, and so forth.
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So two things I have in mind that I want to ask you about is number one, what is it as such as with I guess you know, the prior authorization with these members that are within the ACO?
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What is that kind of approval percentage about?
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Like, is this are are they being denied for a lot of the treatment that they want to be able to provide to their patients?
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And then also two, if they are a part of this ACO, how much of a a new burden is put on them as far as reporting and so forth?
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And is that all on them, or does Ashrana Health help out with those wraparound services?
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Yep.
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Um in terms of prior off and approvals, the good thing about this ACO program is that their experience will be completely unchanged by participating in the ACO.
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Um CMS or the and the regional Mac continues to play that function for this original Medicare population.
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So the practice will continue to bill their Mac, the Mac will continue to play the role of authorization, they will be adjudicating claims, they will be making denial decisions.
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That role will not be impacted by the program at all.
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And further, the from a beneficiary perspective, their benefits won't be changed, their choices won't be changed or reduced.
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There's really no negative impacts from an authorization network service access perspective, either on the part of the provider or the beneficiary.
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So I think that's really important and a big difference between these original Medicare ACOs and maybe Medicare Advantage.
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Um in terms of burden at the practice level and some of the wraparound services.
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So that those questions and these issues are exactly why Astrana does what we do in this context to help enable these independent primary care providers and practices to participate in these programs.
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Um we handle the value that we add is by by making these programs accessible and not burdensome to participate in while they're able to benefit financially and clinically.
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To be more specific, we of course handle all of the the actual programmatic pieces of maintaining the ACO, all of the reporting, the actual work, contracting work, compliance, all of those things.
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The wraparound services that we provide, we feel at Astrana we have truly industry leading wraparound services.
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Um, technologically, um we have a custom in house AI driven platform that provides a host of capabilities for providers in the form.
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Of a provider portal that can help drive their workflow, raise patient lists, notify ADT notifications for when patients are in the hospital, provide insights on utilization and a host of other things.
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We also provide clinical and care management wraparound support services, not in a manner that is coming into the practice or changing a provider's workflow or anything like that.
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Things like when we know a patient's in a hospital trying to communicate and help to facilitate scheduling a follow-up visit.
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If a patient's in a hospital at an institution in California that we have a physical on-the-ground presence in, you can visit with that patient, help to facilitate transitional care services, make sure that they have a proper discharge plan and are in contact with their primary care provider to get seen after discharge.
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We also provide risk adjustment or coding as well as quality support services to help focus not only on outcomes and documentation, but also taking care of the reporting function as well.
00:23:16.960 --> 00:23:22.000
Tyler, you had signposted uh sustainability as a theme that you want to touch on.
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And I'm curious for a provider that enters into this relationship, how does that change after year two, year three, year five?
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What can providers look forward to?
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Yeah, um so we we are a proud astronaut and and specifically within the ACO program for conducting ourselves in a way that delivers sustainable results.
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Um from an astronaut perspective, the company overall we have over 20,000 physicians in in the network.
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Overall, we've we have a provider retention rate of over 98% and an average provider tenure of over 11 years.
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So globally at the astrona level, feel like that is a reflection of consistently delivering on the financial and operational commitments that we put forward.
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From an ACO perspective, um we've been in this business for a long time.
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Um and we're proud to say that we've delivered positive shared savings for 12 years in a row, looking to make uh 2026 number 13.
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Across those years, we've generated nearly a billion dollars in gross shared savings as part of these ACO programs.
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Um and we we do that by taking a pragmatic and sustainable approach uh to our qualification and our actuarial processes to make sure that yes, we're trying to grow, but we're doing so in a responsible way so that we're bringing partners into the ACO that belong there and that benefit the rest of the uh providers that are already here.
00:25:13.920 --> 00:25:14.480
That's great.
00:25:14.640 --> 00:25:23.599
So so, Tyler, just to wrap up on this, because I I mean PAC is obviously super excited about this collaboration uh to promote this opportunity.
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If a provider wants to learn more information, you know, directly from Ashrana Health, uh do they have a phone number they call?
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Do they they go to your website?
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Any information you can share about that?
00:25:36.240 --> 00:25:37.359
Yeah, great question.
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Um, we've been working with the team at PAC to create um customized and purposeful collateral and material about our ACO programs.
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We have a dedicated landing page uh within the Australia Health website uh for this purpose.
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I would I would recommend that folks refer to uh some of these links and materials that are being provided to all of the PAC members and being made available on the PAC's website as well as through various social channels in order to get connected with myself and team to explore the next steps.
00:26:12.319 --> 00:26:12.640
Great.
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Thank you so much, Tyler, for your time.
00:26:15.440 --> 00:26:16.880
Of course, thank you for having me.
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I greatly appreciate it.
