At last Connecticut has two medical groups that have been approved to participate in Medicare’s Accountable Care Organization (ACO) program. The two groups are: MPS ACO Physicians in Middletown and PriMed of Shelton. The ACO program is part of many efforts being undertaken to change how health care is both delivered and paid for; moving from a system that rewards volume to a system that rewards quality care and better outcomes.
ACOs are formed by providers – often large medical groups, sometimes a partnership between hospitals and their medical staffs. Because Connecticut doesn’t have a lot of large medical groups, movement toward this model of care has been slow when compared with neighboring states.
The participating providers in an ACO are given a panel of Medicare fee for service patients and asked to improve their care through better monitoring and coordination. ACO performance is gauged by a series of quality measures. Those measures are divided into four categories:
|Categories||Examples of Measures|
|Patient/caregiver experience||How well your doctor communicates
Access to specialists
|Care coordination/patient safety||Inpatient readmissions
Medication review after inpatient discharge
Screening for fall risk
|Preventive health||Flu shots
High blood pressure screening
Weight screening and follow-up
|At-risk populations: management of chronic conditions||Specific measures for: diabetes, hypertension, coronary artery disease, congestive heart failure, high cholesterol|
The ACO model is based on the presumption that improved quality will actually save money. If quality standards are satisfied and the rate of increase in health costs is slowed, those savings are shared between the provider group and Medicare.
By setting quality standards, Medicare is assuring that providers will be rewarded for effective care, not for under-treatment. Patient participation in a Medicare ACO is completely voluntary.
Jill Zorn is the Senior Program Officer at Universal Health Care Foundation of Connecticut.