Health care has not met goals

Accountable care organizations are not meeting their goals in Minnesota.

Kristina Busch

When most Minnesotans visit the hospital, they pay for the services they receive.
 
But if hospitals and clinics partner with accountable care organizations, patients could pay for the quality of provider care instead.
 
The care model, which exists in about 50 percent of Minnesota clinics and hospitals, including Fairview Health Services, works to lower health care costs and improve patient treatment statewide.
 
Still, a Minnesota Department of Health report released last week showed ACOs will have to increase doctor-patient transparency, invest in technology and focus on patients with complex diagnoses to reach their full potential.
 
Most of the state’s ACOs focus on improving conditions in hospitals, MDH Health Economics Deputy Director Cara Bailey said.
 
“These hospitals use ACOs not only to improve quality of care but manage costs and encourage continued care from a patient,” she said. 
 
Fairview Vice President of Revenue Management Andy McCoy said ACOs are mainly responsible for making sure patients are healthy.
 
“We share with either the health plan or the employer the risk around the cost of that patients’ services over the year,” McCoy said. 
 
ACOs also coordinate patient care with their doctors, he said.
 
Still, the model is utilized primarily within larger health care providers, though the report recommends ACOs expand to smaller clinics and hospitals.
 
As an ACO, Fairview agrees with insurance companies to keep the costs per patient below a certain level, McCoy said. If that agreement is met, Fairview splits the cost of the patient with the health insurer.
 
“Let’s say, on average, the cost of a patient is about $400 per month,” he said. “We’ll set up a risk arrangement with the health plan that says, if the costs are below $400, we get to share in the reduced costs, so we have an incentive to make sure costs are lowered.”
 
He said part of the deal is making sure patients aren’t  undertreated as a result.
 
Though ACOs are spreading statewide, clinics and hospitals involved haven’t yet reached their goals in two-thirds of their target areas, like disease and patient management.
 
About 30 percent of ACOs were deemed “mature,” or competent in all seven measured categories. Goals in planning and following-up with patient treatment were best met while disease management was lowest across ACOs statewide.
 
In accordance with report recommendations, Fairview is working with its doctors to make patient visits less frequent but more effective in getting necessary information for treatment, McCoy said.
 
“If a patient has been in one of our hospitals, we have a process where we call that patient after their visit to check why they made a visit and if they could have gone to a primary care facility because it is lower cost,” he said. “It is an education process because we work with our patient and their health over an extended period of time.”