Delaware Valley ACO CEO Mark Angelo on the future of value-based care

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This week’s Making Rounds spotlights Mark Angelo, a physician and CEO of Delaware Valley Accountable Care Organization (DVACO) in Villanova, Pennsylvania. Angelo talked about the challenges of running an accountable care organization (ACO), or a group of providers and payers that join together to provide quality care while reducing unnecessary healthcare spending. Angelo also laid out his projections for the future of value-based care.

This interview has been lightly edited for length and clarity.

How would you describe your job to someone who doesn’t work in healthcare?

Our value-based care organization convenes providers and payers to improve the quality and cost of care. We decrease unnecessary hospitalizations and focus on ambulatory sensitive conditions—things that should be managed in an outpatient area so people don’t have to be hospitalized unnecessarily.

We work with any payer that’s willing to work with us, and that’s actually significantly appealing to providers because providers don’t want to deliver different care to different patients. They don’t want to have to worry about “Is this a Medicare patient? Or is this a patient who has Medicare Advantage? Or is this a Humana patient?” They want to just be able to deliver the best care that they can. It’s of great benefit to everyone, really.

As CEO, I get to oversee a number of aspects of care for the patient: how we decrease the cost of care, how we pick our populations of focus, how we’re going to decide who our riskiest patients are, and how we help to drive care coordination services toward a particular sort of patient. I also still see palliative care patients.

What would you consider the most challenging part of your job?

The most challenging part of accountable care is that patients don’t understand they are part of an ACO. There are 250,000 covered lives under DVACO. I would bet that fewer than 10% of them know they’re in an ACO. One of the biggest criticisms of accountable care—and I agree with it—is that we don’t engage the patient closely enough in value-based care, so they don’t generally know that they’re a part of this. And I would say that even some providers don’t recognize that they’re a part of the organization. You’re always going to get better results if everybody’s pulling in the same direction. If patients aren’t aware of our goals to improve quality and improve costs, they may not understand why we’re pulling in one particular direction or another.

What healthcare trend are you most optimistic about, and why?

The Centers for Medicare and Medicaid Services mandate for all beneficiaries to participate in a value-based arrangement by 2030.

Do you think the 2030 goal is feasible?

Well, what we’re doing is changing the paradigm of care. If you thought we were going to change the paradigm of care in five to 10 years, you shouldn’t be surprised that you were wrong. That doesn’t mean that value-based care is not moving forward. Look at things like the move toward Medicare Advantage—that’s a value-based care program, and we see the numbers in Medicare Advantage increase every year. Fifty percent of all [eligible] Medicare patients at this point are now in a Medicare Advantage agreement.

I do believe there are detractors, and there are a lot of people and health systems who have made a lot of money in fee-for-service revenue. They may be reticent to see change coming down the road. But I do believe there is change coming.