Accountable Care Organizations: Iowa’s Opportunity and Challenge

Recently our hospital announced that University of Iowa Health Care in Iowa City, Iowa and Mercy Medical Center in Cedar Rapids, Iowa have been selected by the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Shared Savings Program Accountable Care Organization (ACO). The ACO is sponsored by CMS and the goal is to offer patients high quality service and care through a partnership with CMS.  Another goal is to reduce growth in Medicare costs by enhancing care coordination. You can read more about the Shared Savings Program at the CMS ACO website at Accountable Care Organizations (ACOs) – And You, the Official U.S. Government Site for Medicare. I’ve also posted about this before and you can view that at ACOs for Psychiatry: Value-Added Services « The Practical Psychosomaticist: James Amos, M.D. By way of review, an excerpt from that post about the definition of ACO:

One definition of ACOs is from an article in the April 2012 issue of Psychiatric Times, the text of which orginally appeared in the April 2012 issue of Physicians Practice:

An ACO is an organization of healthcare providers that can receive additional funds from Medicare (and an increasing number of private payers) if it can demonstrate that it provides higher-quality care at reduced costs to a defined group of patients. An ACO must measure quality, outcomes, patient satisfaction, and cost, for which it will need a sophisticated IT infrastructure, and it must form a legal organization to receive and distribute shared savings among its providers.

The regulations governing Medicare’s new Shared Savings Program have formed the framework around which ACOs will organize. To participate in that program, an ACO must:

• Define processes to promote care quality, report on costs, and coordinate care.

• Develop a management and leadership structure for decision-making.

• Develop a formal legal structure that allows the organization to receive/distribute bonuses to participating providers.

• Include the primary-care physicians (PCPs) of at least 5,000 Medicare beneficiaries.

• Provide CMS with a list of participating PCPs and specialists.

• Have contracts in place with a core group of specialist physicians.

• Participate for a minimum of three years [1].

Another target for building ACOs is now Medicaid, and there was an interesting article about this in the July 9, 2012 issue of American Medical News, Are ACOs the answer for Medicaid? –

I’ve not heard much so far about how to optimize health care for patients with both mental and medical disorders except from Dr. Roger Kathol, MD, CPE, Founder and President of Cartesian Solutions, Inc., a champion in coordinating care for those with complex, comorbid medical and psychiatric illness. A summary of his take on ACOs is at Cartesian Solutions – Care Delivery Systems.

Although in my experience, I’m not as confident as Dr. Kathol about a psychiatrist’s ability to make enough of an impact on chronic, severe psychiatric illness to lower the enormous costs of health care, I still believe in the basic premise. If we don’t address the psychiatric illness that often leads to and exacerbates the burdens of medical illness and vice versa, we’re unlikely to make a dent in health care expenditures. True coordination of care involves taking a comprehensive look at the whole person and his or her complex context, including the behavioral, social, spiritual, and systems barriers.

1. Nelson, R. (2012) ACOs: A Guide for Physicians. Psychiatric Times