It has become the new mantra among health care professionals: “Better care, improved health and lower costs.” Despite the uncertain future of the federal health care reform law, many in the industry say the three goals of that oft-heard mantra already are driving changes in the system.
Better care by physicians and other providers, improved patient health and lower costs for  both patients and health care payers are the aims of the Accountable Care Organizations, or ACOs, being formed this year around the country. A key initiative of the Affordable Care Act,  ACOs are voluntary groups of doctors, hospitals and other providers formed to provide coordinated care that measurably improves quality and saves health care costs.
In Westchester County, the two largest physician group practices recently have ventured into ACO collaborations with the federal government and private insurance companies. WESTMED Medical Group, a 220-physician group based in Purchase, in March announced the launch of an ACO in collaboration with UnitedHealth Group. It will serve Westchester residents covered by UnitedHealthcare”™s Oxford health plans at WESTMED offices.
The 280-physician Mount Kisco Medical Group, the county”™s largest group practice, this month was chosen as one of 27 pioneering ACOs in the Medicare Shared Savings Program launched by the Centers for Medicare and Medicaid Services. The program covers traditional Medicare patients receiving fee-for-service care.
Participating providers, which include the northern Westchester medical group”™s Accountable Care Coalition of Mount Kisco L.L.C., stand to receive 50 percent of  savings in Medicare expenditures calculated by federal officials. The savings will be determined by comparing a patient”™s annual ACO care costs with Medicare”™s past expenditures for that patient over a three-year period.
Mount Kisco Medical Group is partnering in the ACO venture with another Westchester-based health care company, Universal American Corp. in Rye Brook, and Universal”™s Houston-based subsidiary, Collaborative Health Systems. The Universal company is partnering with nine of the 27 ACOs selected by Medicare, including another physicians group in northern New York state.
A provider of health insurance and managed care plans, Universal has built its current business on the Medicare Advantage plans provided by private companies to enhance traditional Medicare coverage. “Everything we”™ve done with the ACOs is built on what we”™ve done in Houston” to collaborate with doctors treating Medicare Advantage patients, said Richard A. Barasch, chairman and CEO of Universal American Corp.
A publicly traded company, Universal American last year sold its 5-year-old Medicare prescription-drug plan business to CVS Caremark for $1.25 billion. Last month, the company, seeing a growth opportunity in the Medicaid managed-care sector, closed on its $227.5 million purchase of APS Healthcare, a specialty health management and services company that primarily services Medicaid agencies.
APS Healthcare in late 2008 relocated its headquarters from Maryland to 44 S. Broadway in downtown White Plains. Universal American, headquartered at 6 International Drive, plans to consolidate its Westchester operations with its newly acquired company.
“It”™s a very entrepreneurial company,” Barasch, a New Rochelle native, said of the business he has led for more than 20 years. “We”™re very flexible. We jump on things.”
At Universal American, “We believe that ACOs is one of the next things that require a great deal of attention,” said Barasch. The Affordable Care Act and the ACO initiative, he said, are responses to “this fundamental problem at every level of the health care system” ”“ how to control costs while improving the quality of care.
Barasch said Universal”™s Texas subsidiary, Collaborative Health Systems, will assign a nurse as care coordinator and case manager for Medicare patients treated by Mount Kisco physicians. The company also will handle Medicare fee applications and compliance matters for the ACO.
By providing more primary-level care for patients, the ACO partners should reduce the need for more specialized and more expensive care and hospitalizations, said Barasch.
With a nurse coordinating care, Barasch said the company expects to reduce a major Medicare “budget-buster,” hospital readmissions, for its ACO partners. “An enormous number of readmissions can be prevented just by making sure that the aftercare is appropriate” and is followed by the patient, he said.
“Being partnered with Mount Kisco (Medical Group) is a huge coup for us,” Barasch said. “We”™re delighted to be in their company.”
Both Barasch and the physician group”™s CEO said cutting patient costs in the Mount Kisco practice will be more difficult to achieve than at ACOs that are less efficient and less technologically advanced. The Mount Kisco group converted to electronic medical records 15 years ago, long before the Affordable Care Act required health care providers to convert to digital recordkeeping.
“I think it”™s important to Mount Kisco to be an ACO,” said Dr. Scott D. Hayworth, who has led the group practice since 1996. “The really hard part is in the cost savings. I think it”™s going to be tougher for us to save on costs.”
“I don”™t think the health care law that was passed is going to save the country money,” sad Hayworth, whose wife, Nan, is a Republican member of Congress.”Unfortunately, if we don”™t figure out a way to reduce costs for the American people, people aren”™t going to be able to afford the insurance.”
The Medicare shared-savings ACO “is a good model for us, to sort of put our toes in the water and try to find ways to improve our model and try to find ways to bend the cost curve for our patients,” Hayworth said.
Hayworth said the Mount Kisco group also is talking with private insurers about forming ACOs. “You always try to start somewhere with a test model and make sure it works,” he said.
Following its ACO alliance with UnitedHealth Group, WESTMED Medical Group this month joined Cigna Corp. in a similar collaboration of provider and insurer. Cigna started its accountable care program in 2008, before the federal health care reform bill was adopted, and now has 22 partnerships in 13 states covering more than 270,000 customers.
Hayworth stressed that patients will benefit from the ACO system. “In no way will this hurt a patient”™s care,” he said. “In no way will this be a negative to the patient”™s care.”
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