Under the new federal health reform law, groups of doctors that coordinate care for their patients can share in savings they produce.

By Kelsey Tsipis

Two North Carolina-based health care groups have been selected to join a new Medicare program designed to improve care for seniors while lowering costs.

Cornerstone Health Care in High Point and Triad Healthcare Network in Greensboro are among 89 new Accountable Care Organizations chosen by the federal Centers for Medicare and Medicaid Services across 40 different states. The decision, announced by the federal Department of Health and Human Services this week, brings the total number of organizations participating in the Medicare initiative to 154, with five of them in North Carolina.

As created under the federal health reform law, ACOs are networks formed by groups of doctors, hospitals and other health care providers to receive financial incentives for coordinating care for people with Medicare, the federal health insurance program for seniors and people with disabilities. Triad Healthcare Network and Cornerstone Health Care, made agreements with CMS to monitor the quality of care for Medicare patients in exchange for a share in savings they realize.

“The major difference is that doctors will be better informed about the medical conditions of their patients because they’re communicating with all providers,”  said Andrew Weniger, a director at High Point-based Cornerstone Health Care. “Patients won’t have to fill out as many medical forms, or receive redundant medical tests.”

Cornerstone is a network of 313 physicians who started serving 12,000 Medicaid beneficiaries beginning July 1st. Triad Healthcare Network, is comprised of networks of individual practices – along with Moses Cone Health – with 759 physicians, and will serve about 34,000 Medicare beneficiaries under the program.

The two new ACOs join Coastal Carolina Quality Care, Accountable Care Coalition of Caldwell County and Accountable Care Coalition of Eastern North Carolina as North Carolina-based early adopters of the new model of care called for in the federal health reform bill. The existing North Carolina ACOs, combined, are currently serving about 26,000 beneficiaries.

“Better coordinated care is good for patients and it saves money,” said Health and Human Services Secretary Kathleen Sebelius in a press release.

North Carolina creates the model

North Carolina’s Medicaid program served as a precursor to ACOs when state healthcare leaders created Community Care of North Carolina in 1998. Medicaid is the state and federally funded program that covers care for the disabled, low-income children, and some poor adults.CCNC was one of the first “medical home” practices in the nation, and the model has been refined over the past decade-plus.

Each Medicaid enrollee is assigned to a specific primary care provider or clinic. “Care managers” – usually nurses or social workers – work with doctors and hospitals to coordinate the care for these patients and help them navigate the health care system. The CCNC program has built networks with hospitals, physicians, health departments, and social service organizations all over the state.

CCNC has gotten national notice because because the model has been shown to reduce costs, improve coordination, and better align economic incentives for providers, payers, and patients. The program has saved the state close to a billion dollars over a four year period, according to an independent analysis examining four years of state Medicaid cost data.

According to the US Department of Health and Human Services, as of July 1, more than 2.4 million beneficiaries across the county are receiving care from providers participating in ACO Medicare shared savings initiatives.

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