New Partnerships to Coordinate Care for Medicare Patients

Ed note: this was originally posted on the Healthcare.gov blog

The Affordable Care Act is bringing real change to a health care system that has cost us too much and could do a better job to keep Americans healthy.  As a result the law, the Department of Health and Human Services has been partnering with doctors, nurses, hospitals, and other medical providers to help patients get the best care anywhere.

Accountable Care Organizations, or ACOs, are one of these new ways for doctors, hospitals, and other providers to be rewarded based on the quality of care they provide for patients, not just on how many tests they order or how many procedures they do.

Today, HHS announced 27 new ACOs have joined this partnership – and over 150 more potential ACOs have submitted an application to begin in July.  There is enthusiasm and energy behind this program from all parts of the country, from all parts of the health care sector.

Already, 32 “Pioneer ACOs” representing health care groups with experience coordinating care for patients have been participating in a special demonstration program since the beginning of the year to improve Medicare beneficiaries’ health and experience of care, and reduce growth in health care spending.

We’re seeing some examples of progress just three months into the program:

  • Plus in Northern Texas has begun putting in place multiple screening pilots to target beneficiaries who are at high-risk for specific diseases. This ACO is starting with a Colorectal Cancer Screening pilot, and it will be adding other pilots in the coming months.
  • The Seton Health Alliance in central Texas has hired nurse navigators to support high-risk beneficiaries with multiple chronic conditions.  The nurse navigators invite patients to participate in Advanced Care Coordination Clinics where an individual patient may spend as much as an hour with a designated primary care provider who specializes in longer visits for high-risk patients.  The group includes bilingual nurse navigators, who will support beneficiaries whose first language may not be English.
  • Fairview Health Services in metropolitan Minneapolis has focused on improving care transitions that occur between geographic locations—from the hospital, to home care, transitional care, acute rehabilitation or the clinic. The process Fairview uses to support the transition includes using a checklist of transition activities, ensuring communication of the patient’s story (what happened and what care interventions are required) and ensuring that each patient has a patient care plan in their “health care home” that identifies short and long-term goals.

Doctors and hospitals, working together, are changing the way they do business to help improve care for patients.  The great news for Americans is that by doing so, they can improve their patients’ health and also lower health care costs.


Learn more about how the Affordable Care Act is helping Americans:

Rick Gilfillan is the Acting Dir. of the Center for Medicare & Medicaid Innovations
Related Topics: Economy, Health Care, Texas
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