News Feature | August 21, 2013

Are ACO And PCMH Programs Beneficial To Providers?

Source: Health IT Outcomes
Katie Wike

By Katie Wike, contributing writer

Doctor With Bank

Patients receive high quality care through ACO and PCMH programs, now providers are realizing benefits to taking on the financial risks of participating

The Centers for Medicare & Medicaid Services’ (CMS) Pioneer ACO Program “is designed for healthcare organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Services Program. And it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the accountable care organization (ACO), and achieve cost savings for Medicare, employers, and patients.”

EHR Intelligence notes ACOs and patient-centered medical home (PCMH) programs have obvious benefits for the patient, such as providing “patients with high-quality and efficient care.” But are providers benefitting?

Emily Brower, executive director of accountable care programs at Pioneer-participant Atrius Health, told EHR Intelligence, “One of the reasons we wanted to do this program is because we wanted to move from a payer-based approach to how we bill for care to a population-based approach. If you think about a clinician in her practice as taking care of patients, you don’t want to have to think about if they have this kind of insurance then I have this disease management program for them and I have this care management service for them.” ACOs allow doctors to choose programs for their patients that they feel have the best outcome, rather than programs determined by their insurance.

Brower sees Atrius’ participation in Pioneer ACO as beneficial beyond allowing doctors more than treatment flexibility. “The accountable model is the right way to deliver care and will be a more sustainable payment model, not just for us but also for Medicare. That model is the right model and much more engaging for clinical teams to be thinking about this as transforming the delivery of care and improving health and improving the patient experience, not just (although it’s important to sustainability) about reducing cost.”

PCMH programs are proving beneficial to providers as well. PhysBizTech reported that one such program in Michigan saved over $155 million in prevented claims from 2008 to 2011. The Blue Cross Blue Shield of Michigan and researchers from the University of Michigan found that over those three years, the PCMH program “yielded a 3.5 percent higher quality measure, a 5.1 percent higher preventive care measure, and a $26.37 lower per member per month medical cost for adults.”

Additionally, PhysBizTech writes CareFirst BlueCross BlueShield, which covers 3.4 million individuals and groups in Maryland, the District of Columbia and Northern Virginia, reported $98 million dollars in savings in only its second year participating in a PCMH Program. Chet Burrell, President and CEO of CareFirst finds the results encouraging, “The PCMH program was designed with the goal of bending the healthcare cost trend, and our second year results suggest that program is having just such an impact.”