The CORE Institute made several key moves recently to expand the practice and position itself for success in the future.
Based in Phoenix, the practice also has locations in Michigan and will be expanding into additional states this year. In March, the practice signed a partnership with Surgical Care Affiliates and six physicians to open The CORE Institute Specialty Hospital in Phoenix.
"We continue to grow," says David Jacofsky, MD, CEO of The CORE Institute. "The excitement and adoption of our proprietary quality programs and IT platforms for managing risk and predicting the quality and cost of care has been far greater than we ever expected. Now that we have five years worth of data showing outcomes related to the platform deployment for hospitals and physician groups, we're getting calls almost daily from hospitals or groups interested in working with us."
Here are five key notes on the group's growth:
• Last year, The CORE Institute hired 41 providers and 137 staff members
• The group doubled the Michigan practice in the last 12 months.
• The institute had a 40 percent growth for the first quarter of 2015.
• The group plans to expand to Tucson, and has signed a term sheet with a state in the Southeast.
• The CORE Institute signed a co-management agreement with Green Valley Hospital's orthopedics department.
So what's the key to the practice's success?
"The reason we are able to grow so rapidly is we are scalable," says Dr. Jacofsky. "We are standardized both operationally and clinically, which makes it easier to scale and oversee based on best practices and evidence-based consensus. We have a robust leadership program that includes leadership training for physicians."
The CORE Institute University provides training and education for different staff categories to prevent a leadership vacuum. The most challenging part of expansion is the initial move into a new market, but once there, it's easy for the practice to implement existing platforms and increase in size.
"The visibility of our outcomes and quality metrics, and in many cases the costs for consumers and patients, is very attractive," says Dr. Jacofsky. "We are seeing increasing numbers of patients coming from outside Arizona to our facilities, and we are seeing insurance companies that have the ability to directly compare cost, quality and patient experience between different physician groups willing to create narrow networks and steer patients to the facilities they believe will provide the best value."
The group has a proprietary IT platform that includes phone apps, customized electronic medical records, specialized pagers providers use to communicate with each other, and a data warehouse to collect and analyze data in real time. The group invested between $12 million and $15 million on their IT platforms, and has employed six to seven software engineers or programmers in-house for the past half-decade. The IT specialists are responsible for building programs and interfaces to improve value.
"This concept of a virtual care network is an important one," says Dr. Jacofsky. "If you are going to be at risk with payers, you need to be able to take care of the right patient with the right procedure in the right facility at the right time. If every total knee replacement patient were to go to the high acuity hospital or ICU, every episode of care would be expensive. One needs to triage patients between such a hospital and a specialty hospital where we treat relatively healthy patients who need inpatient care or the outpatient surgery center for young total knee patients in the best health. Directed care to the highest quality, lowest cost setting that provides the appropriate safety factor for that particular patient."
The wealth of data allows the practice to participate in bundled payment models based on the surgical episodes and 90 days after the procedure. The practice takes full capitation and full risk capitation per member per month in a manner consistent with population health. They have shared savings models through partnerships with hospitals and insurance companies.
"We have programs where we receive bonus payments if we reach certain rates for patient report cards," says Dr. Jacofsky. "Our biggest challenge has been managing growth and finding the right physician and hospital partners; our growth opportunities have been so extensive that growing and executing efficiently has always been the biggest challenge. This is why the right partner is key."
In addition to the data gathering, the proprietary software programs have had an impact on outcomes, cost and patient satisfaction. In some cases, episodes of care were 30 percent less expensive than their competitors with a lower complication rate based on objective CMS data.
Dr. Jacofsky recently started to publish articles on the use of standardized protocols to improve outcomes for arthroplasty, as well as two or three different papers related to standardization and the use of IT platforms and integrated systems to improve outcomes and lower costs overall," says Dr. Jacofsky.
Dr. Jacofsky continues to look for progressive groups looking to lead consolidation in their state and region.