URBANA — Thousands of Carle and Christie Clinic patients covered by traditional Medicare Parts A and B will be receiving some new wellness services, courtesy of a new Accountable Care Organization.
The added services will be focused on keeping Medicare beneficiaries who aren’t in benefit-richer Medicare Advantage plans healthier without extra cost to them, according to Carle and Christie Clinic.
Accountable Care Organizations aren’t health insurance of any kind. They’re formed under strict Medicare guidelines by groups of doctors, hospitals and other care providers who work together to improve the quality of care patients receive and cut costs.
Medicare, in turn, rewards ACO-participating health systems with financial incentives when they meet certain benchmarks to keep their patients healthier.
One hallmark of an ACO is working to better coordinate patients’ care.
When that coordination is missing, patients can wind up with unnecessary medical appointments and repeat tests that waste time and add costs, according to the Centers for Medicare andMedicaid Services.
The new ACO that Carle and Christie Clinic are involved in is a consortium of seven health systems through Champaign-based Stratum Med, an alliance of physician-led organizations of which Carle is a founding member and shareholder. The other five members of this ACO are health systems outside Illinois.
Stratum Med is working with Missouri-based management company Caravan Health, which builds ACOs and strives to help them succeed.
Medicare patients who are covered under traditional Medicare Parts A and B far outnumber those covered under Medicare Advantage plans, both nationally and in Illinois.
Yet those patients on traditional Medicare aren’t getting the kind of wellness benefits often provided under Medicare Advantage plans, according to April Vogelsang, a senior vice president with Carle Foundation Hospital and Health Alliance Medical Plans.
Health Alliance and Carle have decades of experience with Medicare Advantage plans, and they believe they can use that experience through this new ACO to help improve patient health outcomes and experiences and reduce costs, she said.
For example, Medicare patients newly assigned to the ACO may be getting calls in advance of their medical visits asking them to participate in an assessment of their health, according to Vogelsang. Then, when they arrive for visits, they’ll first see a nurse, who will complete those assessments and determine what kinds of preventive services are needed to optimize their health and brief the doctors or advanced practice providers the patients will be seeing, she said.
One such service may be a consultation with a dietician for Medicare patients who need to make changes in their diets to become or stay healthy, Vogelsang said.
While this is Carle’s first venture into an ACO, both Christie Clinic and OSF HealthCare have been involved in ACOs of their own for several years.
Prior to joining into the collaborative ACO, Christie started an individual ACO for Medicare patients in 2013 because the clinic could see some advantages for its patients, according to Joan Shurbet, Christie Clinic’s director of compliance.
OSF HealthCare started a Medicare ACO of its own in a 2012 Medicare demonstration program, according to Josh Sarver, director of accountable care services for the Peoria-based system.
“These were implemented to achieve higher quality of care, improving care coordination among clinicians and facilities and improving patient experience,” he said. “When you put those together, you follow an ACO philosophy.”
That tends to benefit patients systemwide, Sarver said.
“We’ve taken the concepts of what it means to be an ACO, and we’ve applied that to all of our systems, so the patients benefit when they come to our doors,” he said.