EMHS Invited to Participate in Pioneer ACO Model


ACO SigningEMHS is very pleased to be one of the 32 organizations across the United States invited to become a Pioneer Accountable Care Organization (ACO) through the Centers for Medicare and Medicaid Services (CMS). M. Michelle Hood, FACHE, president and CEO of EMHS, said the up to five year demonstration project is intended to improve the coordination, efficiency, effectiveness, quality, and cost of healthcare.

The Pioneer ACO Model is part of the Affordable Care Act (ACA), and is intended to improve the care delivered to Medicare patients. The model is expected to transform the healthcare delivery market as its design is adopted by other insurance companies, including commercial payers and state Medicaid programs. Currently within EMHS, that means approximately 8,000 people in our system included in the ACO. These people receive Medicare benefits and see primary care providers who are participating in the ACO – it is the provider who chooses to participate in the ACO. "Accountable care model demonstration projects will enable hospitals, physicians, and community based healthcare services to work together to make meaningful change to American healthcare. We know that more services and higher spending don't always result in better outcomes – in fact, often exactly the opposite results. With ACOs, the structure of care delivery shifts from how much a healthcare provider does to how well the patient does," Hood said.

To understand what an ACO is, it's important that people first understand what it is not, commented Erik Steele, DO, EMHS chief medical officer. "An ACO is not a health maintenance organization, or HMO, and it does not affect people's Medicare benefits. An ACO does not put the insurance companies in charge of patient care. Accountable care organizations do put the doctor in charge and it is the doctor's responsibility to make sure the patient receives the treatment needed to stay well and out of the hospital." Dr. Steele also emphasized that patients do not lose choices through ACOs, "In fact, some patients may receive more care in more appropriate settings."

The EMHS Pioneer ACO Model will initially focus on Medicare patients that see primary care providers at practices that are affiliated with the Aroostook Medical Center in Presque Isle, Eastern Maine Medical Center in Bangor, and Inland Hospital in Waterville. All three hospitals are members of EMHS. This activity prepares us to incorporate work currently being done with St. Joseph Hospital and Penobscot Community Health Care to expand the collaboration with these and other community partners. Additional work is also occurring with employers in our area to offer this model of care to their employees.

EMHS is uniquely positioned to participate in the Pioneer ACO Model demonstration project, Hood said. "More than 60 percent of our current revenue comes from Medicare and MaineCare. Participation in the Pioneer ACO allows EMHS and its collaborators a strong voice in the architecture of what the future system of care delivery and reimbursement will look like. In addition, we have many of the necessary tools in place, such as leading edge clinical information technology, the Bangor Beacon Community care coordination model, and health plan incentives." Additionally, Hood pointed out that there are 33 measures of quality being carefully tracked through the Pioneer ACO Model. "Basically, accountable care comes down to taking on the responsibility of better coordination of care, building cooperation, and working in such a way that people can live as healthy a life as possible."

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