CEO Blog: Improving Care and Lowering Costs Through NHRMC's ACO|
We believe a program we started this year at New Hanover Regional Medical Center will become the standard in how health care is delivered in the future – with the primary beneficiary being the patient.
Physician Quality Partners, our Accountable Care Organization, began operations on January 1. Once the program is fully operational, patients should notice a significant difference in the way their care is delivered. It will be coordinated throughout the medical community in a way that has never been tried before, with all providers having access to the same information, and with the same goal of providing the right care, with the right quality, at the right time.
In other words, for this program to work like we hope it does, it will depend on our ability to keep you healthy. That’s how patients will benefit, and when they benefit, so do we.
The advent of the “Accountable Care Organization,” or “ACO,” traces back several years, but was given new emphasis with the passage of the Affordable Care Act in 2010. Under the new health care legislation, the federal government has approved a number of pioneer ACO projects to see if they can reduce the cost of providing care by incentivizing coordinated quality care that keeps patients healthier. Not only has our ACO joined that movement, but in an effort to further ensure that health care in the community is coordinated among as many providers as possible, we have also developed a relationship with Physicians Healthcare Collaborative, which is Wilmington Health’s ACO.
The goal of any ACO is to encourage physicians, hospitals and all other components of the healthcare system – pharmacists, home health agencies, skilled nursing facilities and others – to coordinate care by holding them jointly responsible for the quality and cost of the care. The ACO must meet stringent quality goals, eliminating any shortcuts to saving money. The system is designed so that the patient is engaged to make the most informed choice for the right care in the right setting.
While this concept may seem like a basic, intuitive approach to health care, that has not traditionally been the case in our industry. Health care in the United States has been marked by institutional silos and fragmentation. Sharing relevant patient information among all providers to aid in the treatment of the patient has been a barrier that only recently has been solved on a regular basis.
We feel like we have all the components here in Southeastern North Carolina to have a successful ACO. First of all, Physician Quality Partners is physician-led, physician-managed and physician-driven. We firmly believe any reform of the health care system should be led by the providers that patients trust with their care. That is certainly the case here, as we have an outstanding medical staff within NHRMC Physicians Group, as well as other community practice partners who have joined our ACO, to include South East Area Health Education Center, Intracoastal Internal Medicine, and Wilmington Family Physicians.
Hospitals and physicians who participate in the ACO will continue to be paid on a “fee-for-service” basis, which means they will be paid for each service they perform. But, at the end of a performance year, if the total cost of that patient’s care to the payer is below a certain amount, and certain quality measures are met, then participating providers may be able to share in a percentage of the savings.
So now doctors, hospitals and other providers will have an incentive to collaborate on a patient’s care plan and document that in a shared medical record that all appropriate providers can view. The hospital has converted to an electronic medical record, and this region benefits from Coastal Carolinas Health Information Exchange, an excellent regional network that allows providers in this region to share health information in real time in a way that benefits health care providers while protecting patient privacy.
Such collaboration may reduce the need for duplication in x-rays or other tests, and will help ensure that prescribed medications work well together. Patient and family histories will be known right away to providers, especially important in times of emergency.
And perhaps the most encouraging development, ACO partners will be incentivized to ensure patients have access to regular primary care and that a support system to take care of them at home is in place. The community of providers will take into account social issues – such as adequate transportation or housing – along with the medical ones.
Eventually, we expect to enroll multiple insurance plans as well as self- insured businesses into our ACO, and we anticipate that Medicaid will make its patients available for ACO payment in the future.
The fee-for-service model is expected to eventually transform to a full risk model, where ACO systems are paid a set or “capitated” amount of dollars to take care of an entire population. If the total costs come in under that cap, and if certain quality measures are met, then the providers will share in the savings.
Regardless of payment, the most exciting part is that providers will have every incentive to realize the Institute for Healthcare Improvement’s long-standing Triple Aim: Enhance the patient experience, reduce the cost of care and improve the health of the population.
We believe these are the right goals, and we are excited about what ACOs can mean to patients. Providing the highest-quality care is what we do at New Hanover Regional Medical Center, and it turns out that is also the best way to reform our health care system.