32 ‘Pioneers’ Selected To Test New Health Care Model For Seniors

Thirty-two groups were named Monday to test a new health care model, called for in the health care law, which is designed to improve care for seniors while reducing costs.

The groups, which range from Boston-based Partners Healthcare, the largest health care provider in Massachusetts, to the doctor-led Healthcare Partners of southern Nevada, were selected as the first Medicare accountable care organizations (ACOs) by the Department of Health and Human Services.  The networks, which begin Jan. 1, are designed to save $1 billion over five years by promoting coordination between doctors and hospitals and ensuring that people with chronic conditions such as diabetes or high blood pressure get the care they need to stay out of the hospital.

While some lawmakers are calling for cuts in Medicare, HHS Secretary Kathleen Sebelius said the so-called “pioneers” would boost the quality of care for seniors, even as they reduced costs by changing the incentives to reward doctors and hospitals for better outcomes.  “Many of these organizations are finding that doing care the right way can bring down the cost,” she said.

The health care law attempts to use the federal government’s role as payer for Medicare to set an example of paying for quality, rather than for the number of services provided, whether they are needed or not, as is done now.

The 32 pioneers were selected from 80 applicants, officials said.  All have made progress toward, or are already largely functioning as accountable care organizations and will serve as a guide for the dozens of organizations expected to apply for a much larger program, called the Medicare Shared Savings Program, set to launch later next year.

“It’s a wide cross-section of all kinds of organizations,” said Chas Roades, chief research officer with The Advisory Board Company, a research and consulting firm that counsels health care organizations.

Roades criticized a lack of geographic diversity, however.  Six of the pioneers are in California, five are in Massachusetts, but there is only one in Florida, a state with a large elderly population.

The initiative to set up ACOs got off to a bumpy start this year. In March, major industry players were disappointed in draft rules that detailed how organizations would participate and be able to share in the expected cost savings. When applications for the test program came due in August, national leaders in providing integrated care such as the Mayo Clinic and Geisinger Health System passed on joining. In October, however, the final set of ACO rules were released and many organizations seemed to regain confidence about participating. The first round of applications for the larger program are due in January, with those organizations expected to launch as early as April.

Sebelius described the test program as a “super-charged version” of the larger Medicare Shared Savings Program.

In the first two years of a three-year minimum contract, participants will assume greater potential financial risk, but also greater potential reward, said Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation. “These pioneers are not holding back; they’re leaning into the future with this challenge,” he said.

The program serves as a “great test tube,” said Tara Canty, a senior vice president with OSF Healthcare in central Illinois, a network of seven hospitals and more than 650 physicians, which was chosen to participate. OSF is already pursuing several initiatives to coordinate care, she said, including a program to monitor people with chronic diseases and follow up after hospital stays.

“We’re not necessarily changing what we’re doing, but we are being pushed to do it sooner,” Canty said.

As ACOs ramp up their efforts, patients can expect to see changes. Hospitals, primary care providers and others will be communicating more explicitly and pursuing more intensive management of conditions, Roades said.

“One of the biggest challenges,” he said, “is actually going to be engaging consumers in a different kind of health care: one that’s really active.”

Other health care providers are also expected to be watching to figure out whether they want to participate.

Amanda Forster, a spokeswoman for Premier healthcare, an alliance of more than 2,500 hospitals, said the organization has seven pioneers and their experience will be helpful to other providers “from the outset.”  When the larger program takes take effect, there will be more knowledge about what works and what doesn’t, she added.

George Roman, senior director of health policy at the American Medical Group Association, a national trade group that includes some of the nation’s  largest integrated health care groups, said he expects the pioneers in the association to share their experiences with the nearly 400 other members.

List of ACO Pioneers Selected By HHS

Name Service Area Description*
Allina Hospitals & Clinics Minnesota and western Wisconsin A Minneapolis-based system of 11 hospitals and more than 90 clinics and care centers
Atrius Health Eastern and central Massachusetts A Newton, Mass.-based alliance of six medical groups.
Banner Health Network Phoenix, Arizona metropolitan area A Phoenix-based network of 13 hospitals and 2,600 physicians in Maricopa and Pinal counties.
Bellin-Thedacare Healthcare Partners Northeast Wisconsin A partnership between two hospital systems, based in Green Bay and Appleton, Wis., and nearly 700 physicians.
Beth Israel Deaconess Physician Organization Eastern Massachusetts A Boston-based network with more than 1,600 physicians.
Bronx Accountable Healthcare Network (BAHN) New York City (the Bronx) and lower Westchester County, New York A Bronx, N.Y.-based partnership between four hospitals and 2,400 physicians.
Brown & Toland Physicians San Francisco Bay Area, California A San Francisco-based association with more than 1500 physicians
Dartmouth-Hitchcock ACO New Hampshire and eastern Vermont A Lebanon, N.H.-based system including the Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic.
Eastern Maine Healthcare Systems Central, eastern and northern Maine A Brewer, Maine-based system of 10 hospitals and six physician groups
Fairview Health Services Minneapolis, Minn. metropolitan area A Minneapolis-based partnership of seven hospitals and more than 40 primary care clinics
Franciscan Alliance ACO Central Indiana An Indianapolis-based system of three hospitals and about 700 physicians
Genesys Physician Hospital Organization Southeastern Michigan A Flint, Mich.-based partnership between a regional health delivery system and more than 500 physicians.
Healthcare Partners Medical Group Los Angeles and Orange Counties, California A Torrance, Calif.-based independent practice association of more than 4,200 physicians.
Healthcare Partners of Nevada Clark and Nye Counties, Nevada A Las Vegas-based independent practice association of almost 2,000 physicians.
Heritage California ACO Southern, central, and coastal California A Northridge, Calif.-based group affiliated with over 100 hospitals and more than 30,000 physicians.
JSA Medical Group South Florida A St. Petersburg, Fla.-based independent practice association with nearly 2,000 physicians.
Michigan Pioneer ACO Southeastern Michigan A partnership between Detroit Medical Center and more than 200 physicians
Monarch Healthcare Orange County, California An Irvine, Calif.-based independent practice association with 270 physicians.
Mount Auburn Cambridge Independent Practice Association (MACIPA) Eastern Massachusetts A Cambridge-based independent practice association with over 500 physicians
North Texas ACO Tarrant, Johnson and Parker counties in northern Texas A partnership between Arlington-based Texas Health Resources, a multi-hospital system, and a Fort Worth-based practice group with nearly 600 physicians.
OSF Healthcare System Central Illinois A Peoria, Ill.-based system with seven hospitals and more than 650 physicians.
Park Nicollet Health Services Minneapolis, Minnesota metropolitan area A St. Louis Park-based system with more than 1,000 physicians.
Partners Healthcare Eastern Massachusetts A Boston-based system founded by Massachusetts General and Brigham and Women’s Hospitals
Physician Health Partners Denver, Colorado metropolitan area A Denver-based network of independent practice associations with more than 260 primary care physicians
Presbyterian Healthcare Services – Central New Mexico Pioneer Accountable Care Organization Central New Mexico An Albuquerqe-based system with three hospitals and a physicians group
Primecare Medical Network ACO San Bernardino and Riverside Counties, California” A network of 12 independent practice associations and two medical groups, with over 1,200 physicians.
Renaissance Medical Management Company Southeastern Pennsylvania A Wayne, Pa.-based practice association with over 200 physicians.
Seton Health Alliance Central Texas An Austin-based partnership with 13 hospitals and 90 primary care physicians.
Sharp Healthcare ACO San Diego County, California A San Diego-based system of eight hospitals and several medical groups
Steward Health Care System Eastern Massachusetts A Boston-based system including 10 hospitals and a medical group
TriHealth, Inc. Northwest Central Iowa A Fort Dodge, Iowa-based system including a regional hospital and a physicians’ group.
University of Michigan Health System Southeastern Michigan A partnership between the Ann Arbor, Mich.-based health system and IHA Health Services Corporation, with 175 physicians.
*Based on information provided by participants and the Centers for Medicare and Medicaid Services.