Northwell Health joins Catholic Health Services and the ProHealth network of practices based in Lake Success as three of 24 Medicare accountable care organizations in New York.
A part of the Affordable Care Act, ACOs are a federally designated network of health care providers, including primary care doctors, specialists and hospitals, that strive to better coordinate patients’ care and save money.
ACOs are not paid based on how many tests or procedures they do — so-called fee for service — but by the success of the treatment they deliver. If these ACOs — participants in the Shared Savings Program — save a certain amount of money and reach certain benchmarks on the quality of their care, they get a portion back from the federal government.
The Centers for Medicare & Medicaid Services said on Monday that 532,084 of New York’s Medicare beneficiaries, or a little more than 17 percent of those 65 and older who receive the federal health insurance in the state, will be served by Medicare ACOs this year.
Carole Romano, director of accountable care for ProHealth, said its ACO earned the highest quality score, 95.41 percent, in 2014 and saved CMS $17 million. “This shows that improving quality and saving money go hand in hand,” she said. She said ProHealth, which started its ACO in 2012 and has about 28,000 to 30,000 beneficiaries, will be expanding its care coordinator teams and its home-based illness programs.
Catholic Health Services of Long Island entered into the realm of Medicare ACOs through its affiliation with Beacon Health Partners, a Westbury-based physician network with about 670 doctors. Last year, the Rockville Centre-based health system acquired 50 percent of the Beacon Health network, which included an ACO started in 2012 with about 30,000 Medicare beneficiaries, according to its former chief executive, Dr. Simon Prince. Last month, CHS purchased the remaining 50 percent of the network. It will be consolidated with the existing CHS physician group to include more than 1,100 doctors and be called CHS Beacon.
Dr. Patrick M. O’Shaughnessy, CHS’s chief medical officer, said a major focus in upcoming months “will be to consolidate and better coordinate the care management and care navigation programs of CHS and Beacon Health Partners into one high-performing and efficient system.”
Prince said the ACO saved money and improved quality but not enough to get money back from CMS. “It was a steep learning curve,” he said. Nonetheless, he said, he thinks it’s the right approach. “I’m not sure we’re there yet, but I think we’re on the right track,” he said.
Dr. Fran Ganz-Lord, medical director of Northwell Health’s ACO, said the health system expects between 30,000 to 40,000 Medicare beneficiaries to be included in its new ACO. Northwell, formerly the North Shore-LIJ Health System, had partnered with Bronx-based Montefiore Medical Center’s pioneer ACO in Staten Island and has ACO-like arrangements with some commercial insurers, Ganz-Lord said.
“We’re well positioned to provide this kind of coordination of care,” she said. “This is really not a huge departure from other initiatives but rather a key piece.”