Obamacare's Accountable Medicare Effort Gathers Steam

Posted: Dec 23 2013, 11:46am CST | by , in News


Obamacare's Accountable Medicare Effort Gathers Steam
Photo Credit: Forbes

A new health care delivery system that rewards doctors and hospitals for working together to improve quality continues to gather momentum in the Medicare health insurance program for the elderly.

The Obama administration said today that the voluntary program has attracted 123 new groups of medical care providers known as Accountable Care Organizations (ACOs), an umbrella that links medical care providers to improve quality.

If the providers in the ACO achieve better outcomes, they divvy up money saved with the Medicare program. That brings to more than 360 the number of ACOs that have signed on to participate in the so-called “Medicare Shared Savings Program,” an initiative under the Affordable Care Act.

More than 5.3 million Medicare beneficiaries will be receiving care from these ACOs, according to an announcement this morning by the Centers for Medicare & Medicaid Services, which runs the Medicare program. The figures released today are the latest evidence that the ACO movement is no passing fad.

“Accountable Care Organizations are delivering higher-quality care to Medicare beneficiaries and are using Medicare dollars more efficiently,” U.S. Secretary of Health and Human Services Kathleen Sebelius said.   “This is a great example of the Affordable Care Act rewarding hospitals and doctors that work together to help our beneficiaries get the best possible care.”

The ACO wave is also attracting providers in the private sector where most private insurers like those operated by Aetna (AET), Cigna (CI), Humana (HUM) and UnitedHealth Group (UNH) and most Blue Cross and Blue Shield plans are lining up with ACOs to care for more patients. Here’s a link to a New York Times story from last year that explains how an ACO in Chicago has saved money and improved quality of patient care.

The government-led program works with Medicare contracting with doctors and hospitals through an ACO which, in turn, pushes high quality, less expensive care rather than today’s payment system that often leads to excessive care by paying for each treatment or procedure that isn’t always better. The providers in an ACO are responsible for managing the care of the health plan enrollees and are financially rewarded if the enrollees, or patients, stay out of the more expensive hospital.

“This program puts the control in the hands of physicians and allows them to take the lead in an innovative way to deliver the right care to the right patient at the right time,” Kelly Conroy, executive director of the Palm Beach ACO and South Florida ACO said in a statement provided by the Obama administration.  “We are honored to be a Medicare Shared Savings Program Accountable Care Organization, and after 18 months in the program, can proudly say that we have seen measurable success.  We are so impressed with our participating physicians’ enthusiasm towards the cultural shift, and it demonstrates that physicians are primed for the future of medicine.”

Source: Forbes

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