To make the cut, networks had to show they had the pieces in place, including a spectrum of care providers and the technology to link, track and coordinate care, to achieve a certain level of cost savings while also achieving 33 quality measures. If they hit the goal, they’ll get half the savings they achieve back.
“We spent about a year getting ready, determining whether we were ready for it, getting the application in and getting approval,” said Paul Hiltz, president of Mercy Health Select. The Cincinnati-based network operates six hospitals, including Mercy Health - Fairfield Hospital, and four long-term care facilities, including Mercy Health-Schroder in Hamilton, as well as a multi-specialty physician practice. Independent physicians are also part of the new ACO. The network includes about 22,000 Medicare recipients in Cincinnati and southern Indiana.
Primary care is at the center of the ACO model, and the primary care provider’s role is to give care and coordinate specialty for chronic conditions such as diabetes or heart failure in order to prevent costly emergency room visits and hospitalizations.
The model relies on electronic health records to track tests, procedures, prescriptions and office visits, even sending out reminders to patients that they have appointments or that it’s time to get a prescription refilled, said Dr. Amy Frankowski, Mercy Health Select’s medical director.
The Mercy network set up a data warehouse that keeps track of all the health records and all claims information to Medicare to track costs and savings, said Luisa Hurtado, the director of operations for the network. Through the data warehouse, doctors can also determine which patients are at the highest risk for medical crises and which diseases are costliest to the system so new interventions or procedures can be put in place to improve care.
For the Medicare population, the most common diseases — diabetes, chronic lung disorders like emphysema, heart failure, kidney failure and orthopedic conditions like osteoarthritis — are also the most expensive, Frankowski said.
Nationally, 153 healthcare networks have been designated Accountable Care Organizations by CMS. Enacted through the Patient Protection and Affordable Care Act, ACO programs could ring up $940 million in savings to Medicare over the next four years.
Around the nation, providers are watching and waiting as the new model gets underway.
As with all things healthcare, the rules and regulations governing ACOs are numerous and complex, which could make some providers nervous.
“There’s a lot of regulations to the whole process,” said Jason Koma, spokesman for the Ohio State Medical Association. “And it really requires having a pretty strong infrastructure both of covered lives as well as the physicians and providers who care for those lives.”
Independent physicians and practices have to consider the risks and benefits of being tied to an ACO, he said. There’s also a cost involved in adopting the necessary technology.
At Community Mercy Health Partners, which operates hospitals in Springfield and Urbana, administrators say they’ll be watching and learning from their sister network. Both Mercy Health Select and Community Mercy are part of Catholic Health Partners.
“As ACOs evolve in the future, Catholic Health Partners will be at the forefront,” said Mark Wiener, president and CEO of Community Mercy Health Partners. “That’s going to allow us to really take in all of the learning from Mercy Health Select and apply them directly in Springfield, Clark and Champaign counties.”
With greater pressure on providers and insurers to provide better care at lower cost, everyone involved in healthcare is going to change how they do business, experts say. ACOs are one model, but participation in the CMS programs is voluntary.
Kettering Health Network and Premier Health Partners, Dayton’s two primary health networks, say they’re considering their options.
Kettering Health Network is one of more than 2,600 U.S. hospitals participating in Premier Health Alliance, a North Carolina-based network studying how to improve care and cut costs, said Dr. Gregory Wise, vice president of medical affairs at Kettering Medical Center.
“Kettering is evaluating emerging trends to see what makes sense for our organization as the landscape continues to morph,” Wise said.
Premier Health Partners officials said ACOs are one of the models they’re studying.
“It’s likely that we will pursue an ACO model, but we’re looking at that and a number of strategies to best meet the needs of the community,” said Diane Ewing, spokeswoman for the network.
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