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Pardee joins Mission's accountable care network

Pardee Hospital will become a participant organization in the Mission Health Partners Accountable Care Organization.

This opportunity allows Pardee Hospital and Mission Health to work toward shared goals, while maintaining their independence. The decision comes after months of planning, along with a comprehensive period of evaluation.

Mission Health Partners is a physician-led network of clinicians, hospitals and other health care providers working collaboratively to improve patient care, decrease health care costs and improve the overall health of the community.

"Pardee's participation and collaboration in the development of this newly formed ACO demonstrates our leadership in the transformation of health care delivery in our region," Dr. Robert Kiskaddon, Pardee's Chief Medical Officer, said in a news release. "As a result, we will have a healthier community with providers working closely together to help patients manage their health."

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.

An FAQ published on line by Kaiser Health News explained that the government set up the ACOs to force cooperation and savings in return for higher reimbursement payments to providers.

“The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors,” the Kaiser report said. “When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. … ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work, they have to seamlessly share information. Those that save money while also meeting quality targets would keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward, or they can enter the program with no risk at all.”

ACOs shift the reimbursement of care from a fee-for-service model to a value-based approach where providers work together and are held accountable for the cost and quality of care delivered, Pardee said. ACOs give doctors and hospitals a direct financial incentive for reducing costs, improving quality, ensuring care is coordinated and resources are used wisely at every point along the healthcare continuum.

An ACO is  based on primary care.

"It breaks up the silos of care and addresses issues of transition of care from primary to acute care in a hospital or emergency room setting, and takes in post-acute care," Kiskaddon said. "The original focus will be to participate in the Medicare Shared Savings program, which focuses on Medicaid patients and increasing quality and safety. There’s a financial incentive to improve the health of the population. Previously, under fee for service, the incentive has been to provide care and bill for service."

An ACO rewards “more value than volume,” he said. “Part of the whole process is developing informatics about patient quality and outcomes to the individual physicians. What the collaboration of all the health care providers included in this network will do is use medically proven protocols to improve health care throughout the network,” he said.

It’s not intended to increase the number of referrals from Pardee to Mission or Mission to Pardee. Instead, it demands that the doctors within the network work together and share information on patients. Patients can opt out of the network sharing if they want. UNC Health, Pardee's management partner, is developing its own ACO in the Piedmont. Pardee will share in the informatics  but won't be part of the UNC ACO.

“What they will do is they will look at he savings in health care derived from the ACO,” he said. “If you deliver higher quality care you’ll have fewer complications and fewer uses of health care services. That will decrease costs and as we decrease cost, CMA (the Center for Medicare and Medicaid Services) will redistribute that savings.”

Striving for patient safety and health care efficiency “is in some ways nothing new,” he said. Pardee has targeted both areas and scored high in state and national rankings of patient safety and affordability.

If it can show better patient outcomes for less money, Pardee will receive higher reimbursement rates for Medicare patients. Pardee physicians have been working with the Mission Health Partners program for about a year to iron out details of the partnership. If it works as planned, the county-owned hospital should see higher revenue from the federal government, improved care and reduced cost for claims paid by federal programs and private insurers.

“If you wanted to roll it up into one statement, an ounce of prevention is worth a pound of cure,” Kiskaddon said. “It’s cheaper to keep people healthy than it is to treat them once they’ve gotten sick.”

For more information, call 1-866-790-WELL (9355) or visit www.pardeehospital.org.