Two networks join Medicare cost-lowering

The Arkansas Health Network, owned by the St. Vincent Health System, and Arkansas Accountable Care LLC, formed by the Medical Associates of Northwest Arkansas, will join hundreds of “accountable-care” organizations participating in a program where they will be able to earn rewards for lowering the cost of providing care to patients covered by Medicare.

Nationally, the Medicare Shared Savings Program includes more than 360 providing organizations serving 5.3 million medicare patients, according to the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services.

Participating organizations must serve at least 5,000 Medicare patients and must eventually meet 33 quality measures for providing patient care. Those that reduce the cost of their Medicare patients’ medical services below a certain threshold will receive payments equal to a percentage of the savings to the federal government.

As part of their agreement with the Medicare agency, the organizations can also opt to be responsible for some of the excess cost if the patients’ care exceeds the acceptable range. Organizations that accept that risk are eligible for a greater percentage of “shared savings” is the costs are below the acceptable range.

The Arkansas Health Network includes the St. Vincent Health System’s hospitals in Little Rock Sherwood and Morrilton as well as about 380 doctors. The network’s more than 10,000 Medicare patients will receive notices allowing them to opt out of the program. For those who choose to participate, the organization will identify patients with the greatest need and assign “health coaches” to help some patients navigate the health system and keep up with their medications.

The network also formed an agreement to provide care to patients who sign up for certain QualChoice Health Insurance plans offered on the state’s health insurance exchange, established under the 2010 Patient Protection and Affordable Care Act.

In response to an inquiry made by the Arkansas Medical Society, Commissioner Jay Bradford is reviewing whether QualChoice’s agreements conform with the state’s “any willing provider” law, which requires insurance companies to include in their networks and hospital, doctor or other health-care provider who meets the conditions set by the insurance company.

David Wroten, executive vice president of the Arkansas Medical Society said his group doesn’t have a position on the shared saving program. “Our issue is always going to be; does it provide patients with their choice of physicians,” Wroten said.

Article adapted from the Arkansas Democrat Gazette, 12/27/2013, page 1b.