A new approach to health care under the federal health reform law that rewards hospitals financially for keeping patients healthy at less cost is beginning to yield results in Maine.
Under the model, outlined in the Affordable Care Act, health systems throughout the U.S. are forming alliances of doctors and hospitals called “accountable care organizations.” ACOs are a cornerstone of the federal law that many hope will slow the ever-rising health care costs eating up more and more of Americans’ paychecks.
The experimental approach rewards health providers with financial incentives for keeping patients healthy and happy rather than steering them toward more visits and procedures. If providers reduce costs while providing high-quality care for a certain population of patients, they can share in the savings with the health insurer. Likewise, if they fail to cut costs or miss certain quality targets, hospitals may get pinched financially.
Several health organizations in Maine are experimenting with the new model, and two shared early results this week.
Eastern Maine Healthcare Systems of Brewer partnered with Medicare for its ACO. The health system, parent to Bangor’s Eastern Maine Medical Center, was one of 32 organizations nationally chosen by Medicare, the government health insurance program for seniors, to pioneer the new model.
On Wednesday, EMHS released early data on its “Pioneer ACO” effort.
To be eligible for the incentive payments, ACOs must demonstrate their progress by tracking the health of participating patients through quality measures, such as the number of avoidable hospital admissions and how well providers monitor patients with high cholesterol.
During 2012, EMHS improved its readmission rate — which reflects how many patients wind up back in the hospital a month after being discharged — by 13.2 percent. Its readmission rate — 14.97 percent — was lower than the average rate of 15.42 among all the other Pioneer ACOs throughout the country, according to EMHS.
EMHS also touted another measure that tracks whether nurses follow up with patients to ensure they’re taking the right medications after being discharged from the hospital. That follow-up occurred 91 percent of the time among Medicare patients participating in the ACO, according to EMHS. The average among the other ACOs was much lower, about 72 percent.
As for savings, the EMHS ACO reduced the cost of caring for Medicare patients by 4.9 percent, placing it among the top five of the Pioneer ACOs, according to the health system. EMHS declined to release the dollar amount saved.
The ACO included 9,200 Medicare patients in its first year, and since has expanded to about 14,000 patients.
Patients were happy with their care, with 93 percent saying their providers communicated well and nearly 92 percent saying they felt they were in “good hands.”
The high patient satisfaction scores run counter to fears that ACOs would lead health providers to deny or skimp on care to save money, said Lanie Abbott, an EMHS spokeswoman.
“That wasn’t the case, [patients] had better care, they had more people supporting them,” she said. “I think that’s why they improved either their health status or their quality of life because they actually had more access to care.”
Another fear surrounding ACOs is that requiring hospitals to band together, further consolidating their already considerable market power, will free health providers to hike prices. Health policy experts say it will be a few more years before the full effect of ACOs can be measured.
Tori Gaetani, director of nurse care coordination for the EMHS ACO, and Carrie Arsenault, director of operations, both attributed the early success to EMHS’ work to better coordinate care throughout the health system and the community. The goal is to ensure that everyone involved in a patient’s care — from doctors, nurses, and home health aides to their health insurer — communicate better.
Not all of the Pioneer ACOs have succeeded. Nearly a third dropped out this month after the first year of the three-year program, many struggling to save money.
In southern Maine, MaineHealth, parent to Portland’s Maine Medical Center, took a different path, partnering with a private insurer on an ACO. Through an organization composed of doctors and MaineHealth hospitals, the health system launched the ACO in January 2012 with not-for-profit insurer Harvard Pilgrim Health Care.
During the first 12 months, preliminary results show costs fell by more than 7 percent over the previous year, according to a joint press release Wednesday from MaineHealth and Harvard Pilgrim. The release did not list a corresponding dollar amount.
Inpatient hospital admissions dropped 14 percent and emergency department visits fell 7 percent. That could indicate patients are getter better care earlier, before getting sick enough to need a trip to the hospital.
The health system also maintained its level of health care quality as measured through a Harvard Pilgrim program, the release stated.
MaineHealth and Harvard Pilgrim credited the results to the organizations’ work to coordinate treatment through teams of primary care providers that ensure patients get the appropriate care. Under the approach, a primary care provider coordinates all of a patient’s health needs, such as managing chronic diseases, arranging appointments with specialists, admissions to the hospital and staying up to date on preventive screenings.
“Our collaboration has been a very positive example of the quality and cost improvements achieved for Maine patients when we work together,” Ed Kane, Harvard Pilgrim’s vice president for Maine, said in the release. “ACOs have evolutionary significance for improving patient care — and we look forward to supporting them in other regions of our state.”
The effort with Harvard Pilgrim isn’t MaineHealth’s only ACO. It also has partnered with health insurer Anthem on an ACO, and with Medicare under a model that’s similar to EMHS’ arrangement with the federal government but less financially risky.
Both EMHS and MaineHealth released only a limited selection of their ACO results this week. Neither organization publicized their performance on all of the dozens of quality metrics they track under the ACO model.
How much information ACOs will have to provide to the public remains in question as the project gets off the ground, according to health policy experts.