Why some KC-area hospitals are still throwing their hat into ACA payment model


http://www.bizjournals.com/kansascity/news/2017/01/26/prime-healthcare-aco.html

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A Kansas City-area health network may benefit from its new designation through a pilot program created under the Affordable Care Act — if it isn’t repealed. As an accountable care organization (ACO), physicians affiliated with the Prime Healthcare ACO in Kansas and Missouri could benefit from cost-sharing incentives for Medicare patients.

Specifically, providers and the Centers for Medicare and Medicaid Services would split the savings from reducing costs for a patient through coordinated care, such as not ordering duplicate tests. Of course, ACO providers still must meet key quality metrics.

“It’s looking back at those procedures that have already occurred,” said Paula Ellis, chief nursing officer at Saint John Hospital, a Prime Healthcare affiliate in Leavenworth. “It’s really being a lot more mindful, and looking at all of the information that’s out there. It’s seeing where (the patient) is getting care that their primary care provider doesn’t know about.”

Prime Healthcare also owns Providence Medical Center in Kansas City, Kan., St. Joseph Medical Center in Kansas City, Mo., and St. Mary’s Medical Center in Blue Springs

While savings between different ACO providers have been mixed, Ellis said other markets under Prime Healthcare have found success. The California-based for-profit hospital operator launched its first ACO in California last year.

Its application for the Kansas City ACO model was granted on Jan. 1. It is serving about 10,000 Medicare patients who use Prime Healthcare physicians as their primary care provider.

“The model’s been out there for a few years,” Ellis said. “It has a track record.”

It’s worth noting that the future of ACOs, for the most part, is unknown. The model is part of the Medicare Shared Saving Program, established under the Affordable Care Act, to reduce costs and improve care. A substantial number of providers have adopted it; CMS reported 480 ACOs served a total of 9 million assigned beneficiaries as of January.

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