Editor’s note: This story by Keith Whitcomb Jr. first appeared in the Bennington Banner on Jan. 29.
A Bennington hospital says its experience with an accountable care organization has netted positive results for patient care, even if spending goals were not quite reached in the first year.
Southwestern Vermont Health Care, along with 12 Vermont hospitals and 500 physician practices, joined OneCare Vermont, an accountable care organization, about a year ago. Under OneCare, providers share Medicare data from patients — who voluntarily provide it — to improve health care and lower spending.
Accountable care organizations are designed to shift the medical industry away from the fee-for-service business model, which many say pits the needs of patients against the financial needs of hospitals and medical practices.
The Centers for Medicare and Medicaid Services gives accountable care organizations a target for spending. If an accountable care organization like OneCare Vermont can spends under the target amount, it gets a percentage of the savings back. But the organization can’t simply spend less, the providers must also deliver quality health care.
“We did fairly well in lowering costs a bit, [but] we didn’t really hit that mark. It’s difficult in Vermont, because our costs are relatively low to begin with,” said Dr. James Poole, of SVMC, who sits on the ACO’s clinical advisory board and is a physician quality representative for Bennington County. “To hit the benchmarks, it’s a very difficult thing to do.”
Hospital officials knew the spending goals would be tough to achieve and did not have high hopes of doing so.
“Very few ACOs in the shared-savings program obtained the savings, and the ones that did were in high-cost areas that had a lot of room to improve,” said Dr. Trey Dobson, medical director for Dartmouth-Hitchcock Putnam Physicians.
Beatrice Grause, president and chief executive officer of the Vermont Association of Hospitals and Health Systems, said the savings achieved by OneCare Vermont were not enough for any of its members to receive funds from the shared-savings program. Nevertheless, the hospitals plan to stick with the organization.
“It’s important to look at the big picture and take the long-view on what we are trying to do with accountable care organizations and OneCare Vermont,” she said. “The shared savings is just a small piece of it.”
The real benefit of joining OneCare Vermont is the boost in collaboration between providers and the information-sharing the group has fostered.
“I think the big win in the first year, we’re going into the second year of collections, is the collaboration across the state,” said Poole. “I think for the first time this has been a theater that all hospitals, and offices, and providers have a way to get together in a meeting setting and sharing what’s going in their community, what’s working in their community to improve quality and lower cost.”
Poole said the Vermont Blueprint for Health and OneCare Vermont have meshed well together. “The ACO is a good structure, it’s a good oversight, but the Blueprint is going to the engine, the boots on the ground for process improvement, stuff that needs to get done for overall population management and health care reform,” he said.
Dobson said that by working with the Blueprint for Health, it’s not just hospitals in the ACO working with the population but anyone providing medical care, from private practices to school nurses.
Kevin Robinson, the director of communications for Southwestern Vermont Health Care, said the ACO is essentially a way for providers to learn how to reduce spending in a safe environment.
“It’s about sharing information, it’s about sharing resources, and improving communication, and it’s about bringing people into the tent so to speak who we haven’t thought of prior to this as being important players, like skilled nursing facilities, Meals on Wheels, because the reality is if we want to keep people healthy, that’s the community’s job, it’s not the job of the hospital or a physician practice,” Robinson said.
Contact Keith Whitcomb Jr. at 802-447-7567, Ext. 115.
CORRECTION: Under OneCare, Medicare patient data is shared, not Medicaid data, as originally reported.
