By Taylor Sisk
The North Carolina Medical Society Foundation was last month awarded a $440,500 Kate B. Reynolds Charitable Trust grant to help health care providers in rural communities across the state form accountable care organizations.
The ACO model is based on physician practices making a commitment to preventive care and enhanced coordination of services while meeting quality-of-care benchmarks for a given population of patients.
The overriding objective is to achieve what’s now termed the “triple aim” of health care: a more satisfactory patient experience, improved health outcomes and lower per-capita costs.
The grant will support the formation of up to 15 rural ACOs over the next three years. ACO classification will allow the practices to receive financial benefits from the Centers for Medicare and Medicaid Services. If the practices save money on Medicare patients, they share the savings with CMS.
In 2013, a state legislature-convened advisory group proposed a version of Medicaid reform founded on ACOs, but legislators eventually settled on a different model.
‘Bag of medicines’
The NCMSF has partnered with CHESS, a High Point-based physician-managed health care services organization. According to the press release announcing the grant, CHESS will provide IT support; training in care coordination, patient-engagement skills and how best to integrate community health and faith community resources; and facilitate the “major culture shift as a practice moves to a value-based model of care.”
Lisa Shock is a network-development officer for CHESS and a practicing physician assistant. She practices in rural Person County, and said she has patients who end up in the emergency room or as a hospital inpatient and has no knowledge of it until they arrive for their next visit to her clinic with “their bag of medicines and their [papers] from the hospital.”
Improved care coordination, Shock said, means, for example, more telephone outreach and using every member of an interdisciplinary care team “to the top of their license.”
She said it means reaching out to a patient with heart disease to say, “‘Hey, are you checking your weight? Are you watching your diet? Can we coordinate your care and have a better understanding of what resources you might need?’”
And it means educating patients in how to most effectively spend their health care dollars.
In regards to the IT support CHESS will provide, Shock said an example is looking at claims data available from CMS to look for unhealthy patterns that can be addressed – something particular to a region or a practice.
She said CHESS has developed proprietary tools that assign risk scores.
“So we might say, ‘Mrs. Young has heart failure and she’s depressed and she lives alone.’ Those three things are putting her at higher risk. She’s having trouble breathing and she maybe doesn’t have good family support and is going to call 911 right away. She might need more attention and more monitoring,” Shock said.
“So we use the analytics to make better decisions about what resources need to be provided to patients and how we can deploy different members of our care team to deliver the highest-quality care for that patient.”
The transition to being an ACO, she said, requires a “real mind shift.”
The idea, Shock said, is that providers will be “paid for taking care of patients and measured on outcomes instead of ordering more tests, which is the fee-for-service mentality.”
According to the press release, this initiative will use the Medical Society’s Community Practitioner Program as the “foundation from which to recruit rural practices to take part.”
The Community Practitioner Program steers primary care physicians, physician assistants and family nurse practitioners to rural areas by providing grants in return for service in underserved communities.
“The Medical Society’s thinking is, ‘We have this entire cadre of providers who’ve been providing great care over many years. Why not tap into that as a basis for creating rural accountable care organizations across North Carolina?’” Shock said.
Also eligible for assistance will be federally qualified health centers, rural health clinics, critical access hospitals and hospitals with fewer than 100 beds.
According to the press release, while the initiative will benefit all patients, NCMSF estimates that an average of 60 percent of patients in each participating practice will be financially disadvantaged.[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]