On Dec, 19, 2011, it was announced by the Centers for Medicare & Medicaid Services - CMS - that Trinity Health Systems, which includes Trinity Regional Medical Center, Trimark Physicians Group, Berryhill Center for Mental Health and Iowa Health Home Care, was selected to participate in the Pioneer Accountable Care Organization Model, a transformative new initiative to improve care coordination for patients and families.
Trinity Health Systems was chosen through a competitive selection process and is the only participating health system in Iowa. The selection process began with the submission of a letter of intent, followed by the completion of the full application. Nationwide, 160 letters of intent were submitted and 80 organizations completed the application. In the end, only 32 Medicare Pioneer ACOs will be established in the entire nation.
Working to develop new patient care delivery models that improve care coordination and communication while reducing overall health care expenditures is an important goal for our nation and our organization. The local physicians and hospital have long worked toward becoming a cohesive health care team. A new care coordination model will expand upon that integration, maximizing patient health information to focus on better short-term and long-term outcomes for Medicare patients. The model we develop could serve as a model for expanding patient-centered, coordinated care across the nation.
Since the announcement of Trinity Health Systems participation in the Pioneer ACO program, I have been asked a number of questions. I hope the following information will provide clarity regarding the Pioneer ACO program and our goals to enhance and improve health care for the future.
What is an Accountable Care Organization?
An ACO is a group of doctors, hospitals, and health care providers working together with Medicare to give patients better service and care. The goal of an ACO is for doctors to communicate closely with other health care providers to deliver high-quality care and meet an individual's unique needs and preferences.
As a patient, what is the benefit of my physician being a part of the ACO?
When all health care providers communicate they can give better, more coordinated care. Each health care provider will not only know about health issues that they have treated, they will have a more complete picture of their patient's health through communicating with other health care providers.
By participating in an ACO, health care providers should, over time, provide better, more coordinated health care, where the patient is the center of care. High patient satisfaction is a goal of the ACO.
As a member of the ACO, can a patient still see any doctor or hospital he/she chooses?
A patient aligned with the ACO maintains complete freedom to visit any health care provider accepting Medicare, just as all Medicare patients participating in the original, fee-for-service Medicare do. These patients do not need a referral to see a specialist outside the ACO. Unlike an HMO or managed care arrangement, a patient aligned with the ACO is free to see any health care provider accepting Medicare at any time. In addition, patients maintain all the benefits to which they are entitled in original, fee-for-service Medicare model.
How will the ACO help health care providers deliver better care?
Through information sharing, we will be able to provide the right care, in the right place, at the right time. Medicare will begin sharing information with us about our Medicare patients late January. This information will include things like visits to the doctor or hospital, medical conditions, and prescriptions. Having this information will help doctors and other health care providers and hospitals in our ACO deliver the best care possible, because they will have the most up-to-date information about their patient's health.
However, privacy is very important to us, and the patient controls the use of his/her personal information. Just like Medicare, we put important safeguards in place to make sure all medical information is safe.
What area will be served by the Trinity Health Systems ACO?
The Trinity Health Systems eight-county service area in northwest central Iowa is included in the ACO. The counties included are Buena Visit, Calhoun, Hamilton, Humboldt, Pocahontas, Sac, Webster and Wright.
What is the purpose and ultimate goal of the ACO?
The purpose of the Pioneer ACO is to test innovative care delivery and payment models that improve the health of our patients and reduce the cost of delivering quality care. And through this work we hope to provide better care for our patients, improve the health of the population we serve and reduce health care expenditures.
Why is it important for patients, care givers, health care professionals and institutions to work together?
Through collaboration we will be able to improve outcomes for patients, stabilize Medicare spending now and in the future, as well as, build a healthier community for the next generation.
Our participation in the Pioneer ACO program is an exciting not only for Trinity Health Systems, but for the region. Over the next five years, we will work to redesign the care delivery model to improve health care for our entire nation and each of us. As a caregiver, patient or family member, each and every one of us will all play a role in this exciting journey.
Sue Thompson is president and chief executive officer of Trinity Health Systems.