ardiology keeps the lights on at Dr. Gene Quinn’s office, yet the director of quality and population health for Alaska Heart and Vascular Institute (AHVI) has more ambitious goals.

“My work since residency has really focused on how we build health systems that do a good job, that provide quality of care,” Quinn says. “How do you organize a system of care that does what’s right for the patient? How do we make the right thing, the easiest thing to do?”

Trained as a general internist, Quinn did a fellowship in cardiology. He also completed a master’s degree in public health at the Harvard School of Public Health and a separate fellowship specifically in quality and patient safety.

When he began to practice medicine in Alaska seven years ago, his passion was to build systems. Tending to patients is part of that larger view. “It’s hard to do systems work without knowing what it’s like in the trenches, and it’s hard to convince physicians to work with you if you don’t work with patients,” Quinn says.

About two years ago, Quinn convinced several other practices to join Envoy Integrated Health, a coalition of independent physicians. This year, the coalition is launching an offshoot to apply their integrated model for Medicare patients as an accountable care organization (ACO).

According to the Medicare website, ACO providers communicate with each other to help patients make healthcare decisions. By sharing electronic health records, they can streamline medical tests and paperwork.

“These have been around for decades,” Quinn says, and then the Affordable Care Act of 2010 encouraged more focus on ACOs. “The data over these last twelve, thirteen years is that it provides better care at a more affordable cost,” he adds.

More than 350 ACOs are operating in the Lower 48, mostly owned by large health systems. “Many states have their Medicaid programs use an ACO model,” Quinn says. “Other commercial payers do the same thing; they may or may not call them ACOs.”

Quinn notes that a couple of multi-state ACOs have a presence in Alaska, but Envoy touts its ACO as being the first in the state designed exclusively by local physicians. “We’re putting an Alaska spin on it, making sure it’s locally based,” he says. “We think that the best people to take care of Alaskans are their neighbors.”

As the chief medical officer and driving force behind Envoy, Quinn is conscious of the effect that healthcare decisions have outside of a clinical setting. “What’s most satisfying for me as a physician is the long-term relationships that I get to create with people that I’m going to see. We all shop for clothes at the same place, which is Costco,” he says with a laugh. “We are going to interact with other community members. This is very different from the corporate practice of medicine. That’s one of the reasons Envoy was created.”

As a clinically integrated network, Envoy partners share infrastructure to coordinate patient care, yet all members remain independent practitioners.

“Obviously doctors talk to each other, but it’s really about the system that allows us to do that,” Quinn says. “Independent practices traditionally have been very siloed: we don’t all have the same EHR [electronic health records], we don’t all have the same information exchange that shares data, we don’t all practice in the same building… The downside to having all these silos is that, from a patient standpoint, you can’t have coordinated care.”

Starting with Alaska Heart and Vascular Institute, Envoy formed partnerships with Orthopedic Physicians Alaska, Internal Medicine Associates, LaTouche Pediatrics, Anchorage Fracture and Orthopedic Clinic, Anchorage and Valley Radiation Therapy Centers, and Alaska Digestive and Liver Disease. More than thirty-four physician groups are now integrated with Envoy.

“I’ve had the honor of being able to lead some of these things, but it’s absolutely a group effort,” Quinn says.

Clinical integration, he explains, allows independent physicians to build bridges among their silos. Envoy practices also connect via the state’s healthEconnect Alaska information exchange. The first step to coordinating care, Quinn believes, is building the infrastructure.

“We all have a platform to talk about larger issues than what’s happening in our clinic… issues of coordination of care and population health that span multiple clinics,” Quinn says. “We can be a platform for working with the State of Alaska, working with the Department of Health, for those public health goals.”

The ACO is an offshoot that advances Envoy’s goals. Establishing the ACO lets Envoy work with more partners, such as large hospitals, the Anchorage Neighborhood Health Center, and the Alaska Primary Care Association network of federally qualified health centers.

Coordinated care is just one of the benefits that Envoy anticipates, as the ACO improves communication across various specialties. “One of the things that patients as consumers not only want but demand is that seamless experience where they go to a provider and they know that provider is talking to all their other doctors. They have one central place where they can get everything taken care of,” Quinn says.

Another benefit is patient-centered care. Quinn defines that term as prioritizing the needs and preferences of each patient, promoting shared decision-making. “Being centered on the patient takes into account what the patient’s needs are and meets them where they are,” he says, “enabling that patient to be successful in the complex system that is our United States healthcare system.”

The coalition also touts the potential benefit of better value through preventive care and cost-effective treatment options.

“Value is cost for a given quality. If you’re going to spend money on healthcare, you want to ensure that it’s high-quality healthcare,” says Quinn. “It’s not necessarily bad, in my opinion, to spend money on good care; you don’t want to spend money on bad care, which would be considered low value.”

Quinn notes that high-value care is slightly different from another industry term, “value-based care.” In that case, “Instead of paying for quantity of care (how many things can you do?), you pay for the quality of that care (how well can you do something?),” Quinn explains. Quality is measured by patient outcome. Consequently, rather than many low-value interventions, a patient might be given one high-quality intervention.

The focus of the Envoy ACO on the Medicare-aged patient population is in response to demographic factors. According to the Alaska Commission on Aging, the senior population is the fastest growing demographic in the state. Alaskans older than age 60 now represent more than 20 percent of the state’s total population; this age cohort increased by 68 percent between April 2010 and July 2022.

When providers form an ACO, Medicare administrators allow providers the opportunity to request patients’ medical information. (Medicare patients may opt out of information sharing, if they wish.) The Biden administration set a nationwide goal for all Medicare beneficiaries to be involved in an ACO by 2030.

The Medicare website notes that ACOs are not any kind of insurance plan or health management organization. “Although part of the focus is to be efficient with care, the quality metrics that are involved ensure that ACO participants get high-quality care. We don’t do any sort of rationing; we’re not involved in prior authorization,” Quinn says.

Most of the features of an ACO are invisible to healthcare consumer. Quinn explains, “Most patients that are in an ACO don’t even know they’re in an ACO, and they can get whatever care they want. Our incentive is to improve their experience of care.” To the extent that fewer patients are given expensive procedures or admitted to hospitals, Quinn says it’s because preventive care by coordinating physicians keeps patients healthier in the first place.

The shared goals of Envoy member physicians are providing quality care, improving overall population health, and shifting the healthcare system to prioritize value and quality rather than just quantity. “The physicians of Envoy really want to be part of the solution,” Quinn says. “We really all need to work together. There’s no way you can have meaningful change in something as complex as healthcare without all parties there.”

For a systems-level guy, Quinn is aware that the healthcare industry has a lot of inertia that must be overcome to steer it in a transformative direction.

He’d like to continue expanding the ACO model, working with other payers interested in value-based care. He says, “It is not easy, but it has to happen.”