• ACOs: revamping health care
    By Sara Widness | January 22,2013
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    Names are frequently abbreviated in the health-care industry. Here’s a new one: ACOs. This stands for accountable care organizations, which will be increasingly seen as physicians, hospitals and other health-care professionals coordinate Medicare patient care through cooperative-style networks.

    The goals are better care for patients, and money back from the federal government if the networks save Medicare money.

    But, not all ACOs will be alike. According to the experts at Fletcher Allen Health Care/Vermont Managed Care, there are some half-dozen or so types of accountable care organizations already in effect across the U.S.

    One, called a shared savings program, when fully mature “may incur penalties for providers who care for the population in a way that ends up costing too much,” said J. Churchill Hindes, a spokesperson.

    Conversely, an ACO might split any savings gained with the federal government — the bottom-line goal.

    Hindes is affiliated with an ACO called OneCare Vermont that is affiliated with Dartmouth-Hitchcock Medical Center in Lebanon. Eventually, 300 physicians and participating hospitals around the state will serve much of Vermont through OneCare Vermont.

    The first ACO approved in Vermont was Health First in Chittenden County.

    “Most of the accountable care organizations around the country are relatively small and very focused on a part of a state or city,” Hindes said. Those being formed represent “anything that pertains to shifting the focus of health care to the wellness of a population (in this case Medicare), rather than the wellness of individual patients.”

    “In some respects, this is a melding of long-standing public health principles with long-standing personal health principles,” he added. The networks, like cooperatives, are voluntary relationships to improve the well-being of specifically the Medicare population.

    Incentives are threefold: to slow the rate of increase in health-care spending for the Medicare population; to sustain and/or achieve patient satisfaction; and to accomplish quality clinical practices.

    Patient rights and expectations aren’t expected to be challenged by these structures, nor are benefits from a Medicare perspective.

    “Accountable care organizations aren’t mandated; we don’t have to participate. It [OneCare Vermont] just makes sense,” said Priscilla Latkin, communications specialist at the Rutland Regional Medical Center.

    “If health-care reform goes through from the federal level [the Affordable Care Act passed in March 2010 is scheduled to take effect this month] and if Vermont actually goes single payer, it makes sense for the hospital to have this kind of organization for them to participate in and support each other. We don’t know the benefits yet. It hasn’t been implemented fully. Dartmouth kicked it off; Fletcher joined; we joined.”

    These provider-based entities have a shared goal of improving care and reducing costs initially for Medicare patients, underscored Dr. Trey Dobson, chief medical officer of Southwestern Vermont Medical Center (SVMC) in Bennington.

    “The goal is to coordinate care between, for example, a patent’s primary-care provider and a physical therapist, rather than having care remain in what are known as silos and only focused on specific services,” said Dobson. He added that a goal of an ACO is to develop its own business model that secures maximum care for a patient while controlling costs.

    “The government says if you join an ACO and better coordinate care and drive down the cost of care, we’ll share some of that savings with you,” Dobson said. “It’s an incentivized program to keep people healthy, rather than just paying providers to take care of their ailments.”

    Jim Trimarchi, director of planning at SVMC, added that OneCare Vermont isn’t another layer of medical bureaucracy.

    “Vermont’s leadership hopes that OneCare Vermont will develop and bolster the concept of single payer,” said Trimarchi. “It improves care by encouraging providers to collaborate.” He noted there are 33 quality measures, many of which are preventative care, that ACOs must report to the government.

    If a patient asks about the effects on him/her, Dobson replies, “Better collaboration, better coordination, and better preventative health.”

    ACO goals including reducing re-admissions to a hospital by delivering better care directed to keeping a patient healthy, rather than just reimbursing when a patient is sick; coordinating patient care when high-cost or multiple conditions are involved; assisting care transitions, for example from hospital discharge to a rehabilitation center; and encouraging visits to primary-care offices instead of to hospital emergency rooms. v
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