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This summer, the Centers for Medicare and Medicaid Services (CMS) announced results from the first year of its Pioneer Accountable Care Organization (ACO) model, which seeks to improve care while reducing costs for Medicare patients. The model is a signature initiative of the Affordable Care Act.
Partners HealthCare is one of 32 hospital systems and physician groups across the U.S. that participated in the ACO experiment, and first-year results were positive and promising. Partners was able to reduce the rate of cost growth by 2.4 percent compared to a national benchmark, which translates into $14.4 million in savings for the 52,000 Medicare patients cared for in the Partners ACO in 2012. The savings will be shared equally by Partners and CMS.
As opposed to the traditional reimbursement on a "fee-for-service" basis, hospitals serving as ACOs are paid for managing the health of populations of patients. A major tenet of health reform, already in practice at BWH, population health management is a proactive approach to patient care organized around patients' comprehensive health needs instead of episodic interactions with health care providers.
Population health management invests in services that improve patient access to care, helps patients navigate a complex health care system and provides more information to patients-helping them make the most informed health care decisions. The transition of primary care practices to patient-centered medical homes is helping to make population health management successful at BWH and across Partners.
The significant savings were achieved while also delivering high quality care to Medicare patients. Partners exceeded national averages in nearly all quality indicators tracked by CMS and maintained an extremely low mortality rate.
"As health care evolves in this country, we have an obligation to ensure that we deliver the best value possible to our patients and their families," said Gary Gottlieb, MD, Partners president and CEO. "These results show that it is possible to slow cost growth while delivering high-quality care. We are confident that this Pioneer ACO initiative can provide a blueprint for the rest of the nation to follow."
Four of the five Boston-area health care systems, including Partners, achieved cost savings, though only 18 of the 32 ACOs across the country did. Many agree, however, that proving the ACO model works is more of a marathon than a sprint.
"We know that systemic changes to transform health care delivery and ensure long-term success will take time," said Timothy Ferris, MD, Partners vice president for population health management and leader of the Partners ACO effort. "As encouraging as our first-year results are, it's important to remember that we have much hard work ahead of us to maintain this level of success."
Added Jessica Dudley, MD, chief medical officer of the Brigham and Women's Physicians Organization: "To succeed in population health management, we are working to engage all of our clinicians to identify new systems and processes that will improve the quality, outcomes and efficiency of care. Developing medical homes in primary care, and establishing a medical neighborhood that includes all specialties, are central to improving coordination and collaboration of patient care."