Kentucky Primary Care Alliance accountable care organization saves Medicare nearly $2 million

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By Melissa Patrick
Kentucky Health News

The Kentucky Primary Care Alliance says its Medicare accountable care organization, in its first year, saved Medicare nearly $2 million.

Accountable care organizations were created under the Patient Protection and Affordable Care Act to encourage doctors, hospitals and other providers to work together to provide coordinated patient care as a way to cut back on unnecessary spending. Participants are provided bonuses as a reward for increased efficiency.

“It is really an excellent way of doctors engaging with their patients and making sure they are getting the care they need, all while making sure they aren’t getting a bunch of services that they don’t need,” Barbara Newton, executive director of the ACO, said in a telephone interview.

For example, Newton said, ACOs focus on well-check-ups, prevention and screening, and chronic disease management in hopes of keeping their patients healthy and out of the hospital and emergency rooms.

“What you are really trying to do overall is to improve the health of your patients,” she said. “You get patients used to coming in when they aren’t near death’s door and seeing the doctor and making sure they get the preventive screenings that they need, the vaccines that they need and that they stay healthy.”

She added, “We are just trying to make sure that they get taken care of in the right setting at the right time and that they all have preventive healthcare.”

Newton said the $2 million in “shared savings” would normally be split between Medicare and the participating providers and clinics, but instead they will use their share to help pay down the Centers for Medicare and Medicaid Services innovation grant that allowed them to create the ACO. She added that the hope is that their portion of the savings is large enough next year to pay off the balance of the grant, with some to spare.

The Kentucky Primary Care Alliance opened in 2016 with 10 clinics that cared for approximately 4,400 Medicare patients. CMS estimated that their annual cost would average around $10,450, but the clinics were able to save $450 per patient, resulting in $2 million of shared savings for Medicare. Eight more clinics joined the alliance in 2017.

Critics of ACOs say such programs could encourage providers to skimp on care to earn bonuses, but Newton said the program is set up to require ACOs to meet 33 quality benchmarks that range from patient satisfaction with shared decision making to cancer screenings and preventive vaccines.

“They have very strict quality measures that you have to meet and report on in order to qualify for shared savings,” Newton said. “So you can’t get away with not seeing patients or not providing care. You have to really engage the patients.”

Out of 432 ACOs that qualified for shared savings in 2016, only 134 of them, 31 percent, generated a shared savings, the Primary Care Alliance said in its release.

“These are all rural health clinics and federally qualified health centers, providing services in rural and under-served areas of the state,” David Bolt, COO of the Kentucky Primary Care Association, said in an e-mail. “Their story tells that good quality care at reasonable costs is available in the communities and to the patients they serve.”

In 2016, the Kentucky Primary Care Alliance comprised these clinics: Bluegrass Clinic Stanford in Lincoln County; Bluegrass Clinic Liberty in Casey County; Fairview Community Health Center in Warren County; Health First of the Bluegrass in Fayette County; Lewis County Primary Care Center with clinics in Bracken, Fleming, Mason, Lewis, Greenup and Boyd counties; Sterling Health Solutions, with clinics in Montgomery, Bath and Nicholas counties; Pennyroyal Community Clinics in Caldwell and Christian counties; Triad Health Systems in Owen, Carroll and Gallatin counties; Tri-Rivers Healthcare in Crittenden and Livingston counties; and White House Clinics in Madison, Rockcastle, Estill, Jackson and Garrard counties.

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