The agreement formed between the organizations is called an accountable care organization.
These organizations are typically groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to a group of patients. The goal of these agreements is to figure out how to pay for health care in a way that financially rewards quality, and to get patients the right care, avoid unnecessary duplication of services and prevent medical errors.
Accountable care organizations have also been criticized by some for adding bureaucracy but not meaningfully meeting the goals.
Steve Ringel, CareSource Ohio market president, said to have a successful accountable care organization, you need trust and data.
“So, you build a strong trusting relationship between the two partners, but you verify it with data. ... Do you have data that substantiates everything that you agree to? And that’s what we’ve been able to accomplish is both of those objectives,” Ringel said.
In this case, the accountable care organization between Dayton Children’s, Nationwide and CareSource, dubbed Partners For Kids, is an intermediary between the insurance plans, providers and families, intended to help providers receive reimbursement and focus on preventive care and high-quality sick care.
Nationwide started Partners for Kids 25 years ago and it now includes care for 325,000 children south central and southeastern.
Partners For Kids works with families of children who have complex needs and their providers to ensure all have the information and resources they need; offers quality improvement coaching and resources to providers so they can better offer preventive care and manage disease; and contacts families to schedule well-visit appointments; creates medication prescription guidelines for providers.
Dayton Children’s will be Partners For Kids’ hospital partner in the west central Ohio region, and Nationwide Children’s will continue its relationship with Partners For Kids in the south central and southeastern regions.
Dr. Sean Gleeson, president of Partners For Kids said the model “will enable Dayton Children’s and the provider community to take a more active role in shaping the healthcare system for the children. We look forward to making a difference together for children in the Dayton region.”
Ringel said there are rarely accountable care organizations that do broad geographies but CareSource would like to expand around Ohio. CareSource manages health benefits for nearly 670,000 Ohio children.
“There’s hardly any that do an entire state and our goal is to become statewide with this advanced relationship,” Ringel said.
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