AtlantiCare Health Solutions was one of 106 health organizations announced as an Accountable Care Organization (ACO) by Health and Human Services Thursday afternoon, Jan. 10.
Across the country, this means as many as four million Medicare beneficiaries will have access to coordinated care, Health and Human Services said.
Locally, this means a concentrated effort on patients who are chronically ill and less overall patients, Senior Vice President for AtlantiCare Health Solutions Steven Blumberg said on Thursday afternoon.
“We’re going to take care of patients and keep them well, and it’s OK that services begin to narrow over time, and that the more complex services are reserved for those who really need it,” Blumberg said in a telephone interview. “The goal is a healthier community.”
Health and Human Services representatives described the goal as reducing spending and improving care in a telephone conference with the media on Thursday.
Applications by health organizations for ACO status have escalated since the passage of the Affordable Care Act, President Barack Obama’s healthcare reform plan more commonly known as “Obamacare,.”
According to Health and Human Services, more than 250 ACOs have been established in the last two years, in 49 states. There were 170 applicants this year.
In order to be approved, health organizations had to demonstrate they could serve more than 5,000 beneficiaries. According to Blumberg, AtlantiCare has just under 10,000 beneficiaries enrolled in its program. Health and Human Services representatives stated that those who applied and weren’t selected failed to meet the 5,000 beneficiaries threshold, for the most part.
Organizations also had to provide documentation for a solid care management model. In all, there were 33 quality care measures established by the Centers for Medicare and Medicaid Services (CMS).
“It’s confirmation that our approach is validated,” Blumberg said. “We can see the results of our efforts among our employees and Medicare Advantage and Medicare Shared Savings.”
According to Health and Human Services, the projected federal savings as a result of this program is $940 million over four years. Early results from the program were not available on Sunday.
Blumberg was not able to give a projection for savings locally on Thursday.
However, Health and Human Services issued a report on Thursday stating that growth in Medicare spending per beneficiary hit historic lows between 2010 and 2012, as a result of Affordable Care Act provisions. The organization projected that Medicare spending per beneficiary will grow at “approximately the rate of the growth of the economy over the next decade.”
“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” Health and Human Services Secretary Kathleen Sebelius said. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”
The application process began over the summer, and involved a survey and follow-up questions answered over the course of the fall, Blumberg said. Blumberg said the next step in the process is to contact AtlantiCare’s current beneficiaries, and begin to manage the most complex programs.
Thursday’s announcement also included 15 Advance Payment Model ACOs, which were described as “physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination.” Health and Human Services added that advanced payments will be recouped by Medicare through “future shared savings.”
In 2012, CMS launched the Pioneer ACO program, designed for “large provider groups able to take greater financial responsibility for the costs and care of their patients over time.”
Additional information about the Advance Payment Model is available at http://www.innovations.cms.gov/initiatives/ACO/Advance-Payment/index.html.
More information about the Shared Savings Program is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/
For a list of the 106 new ACOs announced today, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html.
For more information about AtlantiCare programs and services, visit www.atlanticare.org, call the AtlantiCare Access Center at 1-888-569-1000 or Find AtlantiCare on Facebook at www.facebook.com/atlanticare.