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Back in 2011, officials at Seton Health Alliance were anxious to change the way its doctors delivered health care. The Austin-based hospital system didn’t want to get paid just for the sheer volume of surgeries and patient visits their doctors delivered.
Executives wanted to try something new: They wanted Medicare to pay them for taking better care of patients.
Seton Health also wanted to move as quickly as possible. So in December 2011, it became a Pioneer Accountable Care Organization, one of 32 health systems across the country that would — as the name implies — pioneer value-based care, and get paid for hitting certain quality metrics.
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“It was appealing to us because it was the first opportunity and the first start date for one of these programs,” Greg Sheff, the group’s chief medical officer, said. “We really believed in it.”
Seton invested millions moving to a value-based system. It hired new nurse coordinators, to ensure patients got higher quality-care and installed new data systems that made it easier for doctors to talk to one another.
This all makes the next twist in Seton’s story a bit of a surprise: It has decided to leave the ACO program, switching to a separate federal program with a bit more flexibility–and no financial downsides if quality does not improve.
“We knew [signing up for the ACO program] was the right decision at that point in time, but have always thought we would continue to reevaluate,” Sheff says.
The results of the Accountable Care Organizations’ first year, released last year, are a bit difficult to interpret. All the hospitals did show success in improving on quality measures, rates of re-admissions and monitoring of cholesterol levels.
On the other, 14 failed to produce any cost savings – and nearly a third of them also decided to stop participating in the program. Seven switched a different, less aggressive Medicare program, while two dropped out altogether.
“It’s not perfect, obviously,” says Chas Roades, chief research officer at the Advisory Board Company, which advises hospitals. “But no one expected it would be a home run in the first innings. What we’ve heard from a lot of our members is that the first year was a bit bumpy.”
I’ve spent the past few days talking to the ACO dropouts, trying to understand what didn’t work for them and why they went a different path. I tended to hear variations on a theme: They liked the idea of value-based care and still plan to pursue it. They just didn’t see this much-touted federal program as the best way forward. With so many different experiments in the hopper right now, something had to give.
“Administratively, it was very difficult,” says David Spahlinger, executive director of University of Michigan’s Faculty Group Practice. “We had to maintain two different databases, and two different contacts at Medicare. In the end, we decided we would move out of the pioneer program.”
University of Michigan, Spahlinger explained, already had another group of doctors who were participating in the Medicare Shared Savings Program. After a year, it seemed like a waste of resources to participate in two, federal demonstrations. So, for year two, they’ll merge their ACO demonstration into the already existing MSSP.
Date: July 22, 2013