Pen Bay Healthcare Joins Accountable Care Organization Model

MaineHealth, parent of Pen Bay Healthcare, was recently approved to participate in the Center for Medicare & Medicaid Services Shared Savings Program, an important initiative of the Affordable Care Act. Groups of healthcare providers who are selected to participate are called Accountable Care Organizations, or ACOs, and they have demonstrated a capacity to provide their Medicare patients with well coordinated, high quality care. What does that mean to the approximately 35,000 Medicare patients who will participate in this program through MaineHealth member organizations, including Pen Bay Healthcare? 

The goal of coordinated care is to ensure that all patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Our patients won’t need to do anything new, and their relationship with their doctor won’t change. Yet, this program will have a direct positive impact on our Medicare patients, and in turn their families and communities.

The ACO acronym will become a common part of our healthcare language as more and more federal and state healthcare programs and insurance companies move in this direction. The most important word to remember in ACO is “accountable.” MaineHealth and its member organizations such as Pen Bay Healthcare will be held accountable for the care of the 35,000 people in the ACO.

ACOs focus on quality – in a very measurable way. The Medicare Shared Savings Program has a quality component that is as important as lowering costs. Quality is measured in many ways, including through patient satisfaction surveys. If physicians and hospitals working together as an ACO make strides in reducing costs, but don’t meet the patient satisfaction or other quality measures, the ACO will not be eligible for financial rewards. This is a key first step in moving away from being reimbursed simply based on the volume of services we provide, toward reimbursement that is connected to the value and quality of care. 

According to United Health Foundation, Maine is the eighth healthiest state in the U.SThis focus on improving quality, improving the general population’s health and reducing costs is the simple, but powerful goal for which healthcare organizations strive – and for which we will be measured.

For more information, visit www.penbayhealthcare.org/acofaq.