CHARLESTON, W.Va. -- Three of West Virginia's community-owned health centers have seized an opportunity presented by the health reform law, to partner with Medicare to meet their "Triple Aim" of improving the patient experience, improving health-care results and controlling cost.
The non-profit health centers are FamilyCare, New River Health, and Cabin Creek Health which have family health clinics in Kanawha, Putnam, Boone, Fayette, Raleigh and Nicholas counties. The centers together serve almost 60,000 residents each year, over 8,000 of whom are covered by Medicare.
The three health centers formed Mountaineer Accountable Care, LLC and on March 30 submitted an application to Medicare for approval as an Accountable Care Organization to participate in Medicare's Shared Savings program. Encouraging health-care providers to form such organizations is a little-known but potent section of the health reform law. Organized providers that meet the many Accountable Care Organization standards may share the savings that they create with Medicare. The model of care does not restrict patients in their choice of caregiver; nor does it change how services are paid for. It does, however, promote changes in the way care is provided by those caregivers. The big idea is that making some basic improvements in health care will improve results for patients and control costs for patients, for Medicare and other insurers.
To participate in shared savings with Medicare the ACO must produce satisfactory answers to four basic questions related to improving care:
1. How will you promote science and evidence in medical decisions (and not the latest drug rep rap)?
2. How will you coordinate care among primary care providers, hospitals and specialists (so all of a patient's doctors know what each other is doing)?
3. How will the ACO engage patients and families (so they really understand their medical situation and what their options are)?
4. How will you use data to know whether what you're doing is actually working?
The health centers who have organized have a history of working together to improve care for patients with complicated problems thanks in part to support from the Benedum Foundation and the West Virginia Medicaid's Innovation Center. We are ready to answer Medicare's questions.
Medicare approved 32 "Pioneer ACOs" in 2011 (most started by large medical centers) and their early data is encouraging. In the last few days, many more medical organizations around the country have joined with West Virginia's Mountaineer Accountable Care and applied for recognition as ACOs. They also responded to the challenge to be accountable for the quality and cost of care. Opponents of health reform, including some Supreme Court justices, tell us that health reform is a slippery slope to forced broccoli consumption. In fact, however, with its ACO provisions, the law is more likely a slippery slope to better, safer and less expensive health care for all of us.
Carter is CEO of FamilyCare; Robinson is CEO of Cabin Creek Health Center; and Sotak is CEO of New River Health Center.