BREWER, Maine — Penobscot Community Health Care is the latest Maine health organization to join a national effort that rewards doctors for keeping their patients healthy and happy.
PCHC announced Monday that it will join Eastern Maine Healthcare Systems’ “accountable care organization,” a group of providers tasked with better coordinating treatment for seniors covered by Medicare and saving taxpayer money.
Under the model, formalized under the federal health reform law, doctors and hospitals that show they have improved Medicare patients’ health and satisfaction get a cut of any savings in the form of bonus payments. Providers that don’t make the grade either forgo the extra money or pay a penalty.
“You don’t get any financial gain in an ACO unless the most important thing happens, which is you have to demonstrate that your patients are getting healthier and that there’s a very high level of satisfaction by your patients,” said Kenneth Schmidt, president and CEO of PCHC.
The new approach is designed to upend the existing system that pays health care providers based on the number of patients they see and the amount of services and procedures they order. The hope is that doctors, nurses and other providers will work together to keep better tabs on patients’ health.
PCHC is the only organization to join EMHS’ accountable care organization since the system, parent to Eastern Maine Medical Center in Bangor, announced late last year that it was among the nation’s first to adopt the new model. PCHC, a network of community health centers in Greater Bangor, is also the first of its kind in Maine to embrace the approach, according to EMHS.
A portion of PCHC’s roughly 8,000 patients on Medicare, the federal health insurance program for senior citizens, will be enrolled in the accountable care organization, Schmidt said. PCHC serves close to 60,000 patients altogether, most of whom are seniors and lower income.
While the community health center joined the accountable care organization in June, Medicare patients won’t officially take part until Jan. 1, 2013, he said. Patients can continue to see providers outside of the accountable care organization and can also opt out of sharing their personal information with the program.
While PCHC has already shifted toward less expensive and more effective preventive care, the new partnership with EMHS will improve care for chronically ill patients, such as by further reducing avoidable emergency room visits, said Dr. Robert Allen, PCHC’s executive medical director. A patient with uncontrolled diabetes, for example, can check in with a nurse every day by phone or email to make sure blood levels stay in check, he said.
Three other Maine health groups announced a similar effort to improve care and cut costs for Medicare patients earlier in July.