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Lower costs and improve care.
It’s easy for a hospital to say
it’s going to do those things. It’s
harder for a hospital to actually
launch a program to do them—yet
that is what Tri-City Medical
Center has done.
In July, 57 primary care physicians
and Tri-City formed the North
Coast Medical Accountable Care
Organization (ACO) for Medicare
patients. It operates under what is
known as a shared savings program
model, which was created by the
Affordable Care Act.
In an ACO, doctors and hospitals
work together to improve patient care
while keeping costs down. In return,
ACOs can share in a portion of the
money saved by Medicare.
“What you have are primary care
physicians, specialty care physicians
and the hospital working together
as a team, sharing information—and
doing what’s best for the patient,”
said Wayne Knight, executive director
of healthcare reform for Tri-City.
What Does It
Mean to You?
If you have a chronic condition, such
as heart disease or diabetes, chances
are you see more than one Medicare
doctor or provider. A key goal of the
ACO is to make it easier for those
providers to coordinate your care.
One way to do that is through the
use of electronic medical records
(EMRs). EMRs help doctors capture and
manage medical history and, in turn,
make care safer and more efficient. As
a result, you may have fewer tests and
potentially fewer co-pays.
Another goal of the ACO is to
reduce hospital readmissions. So,
at your physician’s request and with
your approval, care management
teams may follow up with you after a
stay at Tri-City to see if you have any
questions about your medications or
other aspects of your care at home.
“If there is better coordination and
communication, the hope is that we
can keep people out of the hospital,”
said Dr. Jeffrey Leach, one of the
primary care physicians in the North
Coast Medical ACO. The ACO has a
total of 33 measures of quality care—
hospital readmissions is just one of
them—on which it will be rated by the
government.
ACOs don’t restrict access to care,
and you can still see any doctor you
choose. So it’s virtually invisible to
patients, Knight noted.
“But under the surface, the quality
is going to improve every year,”
said Dr. Terry Haas, another primary
care physician in the North Coast
Medical ACO.
Leading the Way
The North Coast Medical ACO is
the only one in San Diego County
that operates under the shared
savings model.
“Tri-City is fully embracing the
changes in healthcare reform and is
trying to stay out in front of it and be
a leader,” Knight said. “And this is
one example of how we’re attempting
to do that.”
LEADING HEALTHCARE REFORM
TRI-CITY LAUNCHES ACCOUNTABLE CARE ORGANIZATION
Healthcare Reform
4
Healthy You
|
Fall 2012