Tri-City Medical Center's North Coast Medical ACO is now one of 106 health systems nationwide -- and the only one in San Diego County -- chosen to operate a Shared Savings Accountable Care Organization (ACO) for Medicare patients. The health care-delivery pilot program is intended to streamline and improve care, reduce hospital readmissions and costs and hold healthcare providers accountable for the quality of care they provide.
The announcement last week from the federal Centers for Medicare & Medicaid Services affirms Tri-City Medical Center's commitment to being a leader in health care reform, said Chief Executive Officer Larry Anderson. The ACO program is part of the Affordable Care Act recently upheld by the U.S. Supreme Court.
"This program is a great opportunity for Tri-City and the community it serves and will elevate and strengthen the programs now in place to offer a patient-centered, outcomes-driven, low-cost care setting," Anderson said.
Anticipating the need for such a program in North County, the Tri-City Healthcare District Board of Directors earlier this year approved the formation of the North Coast Medical ACO Inc. The ACO will be administered by a nine-member board comprised of four hospital administrators, two primary care doctors, two medical specialists and a Medicare beneficiary community member.
The North Coast Medical ACO begins with the coming together of 57 primary care physicians who currently care for more than 5,000 patients receiving Medicare, a federal health insurance plan for people 65 years and older and people of all ages with disabilities. In addition, North Coast Medical ACO will partner with 224 specialists and other allied health care providers.
The ACO will serve only Medicare-eligible patients who receive a majority of their care 57 primary care physicians, but Anderson said he envisions taking the lessons learned from the Shared Savings Program and expanding them to include private insurers, as well.
"As others have said, this is the first look at 21st century Medicare," said Wayne Knight, the hospital's executive director for managed care and a member of the ACO's governing board.
The program was effective July 1.
Knight said patients will not see any change in the access to the care they are currently receiving, or the physicians they are seeing. Furthermore, they will retain their freedom to see any physician they want.
Members of the ACO will share in any savings reaped from cutting costs and meeting specific quality benchmarks. They will be rated on 33 core measures such as readmissions, length of stay, diabetes, smoking cessation, access to specialists and how well patients responded to their doctor.