Cornerstone Health Care: On the Cutting Edge of Value-Driven Health Care in North Carolina

Cornerstone is recognized as perhaps the most fully developed example of accountable care in the state at this time. With 367 providers, Cornerstone is one of the fastest growing physician groups in the southeast. It is a physician-owned and led multi-disciplinary practice with over 85 locations in communities throughout central North Carolina.

Dr. Grace Terrell, a practicing general internist, President and CEO of Cornerstone, explains the philosophy behind Cornerstone’s adoption of this model, their experience thus far and why accountable care organizations are here to stay.

Why did Cornerstone decide to go from being a fee-for-service group to form an accountable care organization?
Dr. Terrell: Cornerstone Health Care came to the conclusion a few years ago that although we’d been very successful as a multi-specialty group in the fee-for-service world, that that model, in the long run, was not good for patients and was unsustainable. As we had more and more patients who are becoming older with chronic diseases, and we had higher and higher costs of care, we began exploring other ways that we could get ourselves into a system where we could really have the joy of practicing medicine in the right way again. So, over the course of about a three-year period of time, my physician partners and I decided we’d take the path to lead the value-based world, and really become accountable for a system of care that we believe can be both better and sustainable.

What have been the challenges along the way in changing your model of care?

Dr. Terrell: One of the challenges of being one of the first to do accountable care is that we’re having to invent it as we go along, and sometimes we make mistakes. So long as we continue to focus on the patient and what’s right for the patient, what’s best for the patient, then over time we’re starting to resolve some of those.

For example, we have a heart function clinic that’s for patients with class four heart disease. We know that if we’re able to see them in this clinic on a regular basis it keeps them out of the hospital and provides them better care. But our current payment system is fraught with arrangements where there are a lot of co-pays related to that. So part of the real issue in establishing an accountable care organization is that you’ve got to change the benefit structure, the payment system, at the same time you’re changing the way you’re providing care. So it’s a lot of work, but we’ve found that the further along we get with this, the easier it’s becoming.

The physicians at Cornerstone are passionate that we want to be part of the healthcare revolution that is better than the healthcare system we have right now. So we made time to do this. We wanted to basically roll up our sleeves and figure out how we can do a better job in terms of both controlling costs and providing higher quality for our patients. It’s not just me who’s found time to do this. It’s a whole group of 361 providers at Cornerstone that are doing this together.

What would you say to physicians who are skeptical about accountable care organizations (ACOs) as a lasting solution to an inefficient healthcare system?

Dr. Terrell: There are a lot of physicians out there, I think, that because of all they’ve been through get pretty cynical about this, and say this is the 90’s all over again. This is HMOs. The difference this time around is that our country is broke, and we have a population that is getting older. I believe that it’s absolutely crucial as a profession for physicians to lead this effort. Those physicians that hang around and wait for someone else to solve it, are, in my opinion, suffering from learned helplessness, and that may be what got us in this position to begin with. I think one of the reasons physicians have to do this is because it’s the right thing to do. And if we don’t lead it, someone else will, and I don’t think we’ll like that very much.

Besides, accountable care organizations are already here. In North Carolina we have seven acos currently. Some of them are between groups of physicians and commercial payers, and some of them are Medicare shared savings program and some of them are both. It’s not if ACOs are coming, ACOs are already here. In the US, approximately 10 percent of all patients are already being impacted by being in an ACO.

What options are available to physicians interested in starting an ACO?

Dr. Terrell: ACOs are not just about Medicare. You can have an ACO in any type of arrangement where physicians are contracted to provide care that is related to both quality and cost.

There are a number of different arrangements from an ACO standpoint, that will allow the expense of the infrastructure for an ACO to be affordable for physicians. For example, those that participate in the Medicare shared savings program that are in groups of 50 physicians or less can get some up front monies through the Medicare shared savings program. There are also a number of payers in the private world that are partnering with physicians to help set up ACOs as well as certain other organizations that are creating the ability to have infrastructure such that physicians are going to be able to do this in an affordable way.

The biggest key to success at Cornerstone is that it’s always been about the patient, and we continue to be focused on the patient and what’s right for the patient. The second biggest key is we’re very passionate about our vision statement that we want to be the model for physician-led healthcare in America. We believe that physician leadership is crucial to getting us where we want to be in healthcare.