Delivering Value-Based Care to All Patient Populations
What Is An Accountable Care Organization?
Accountable Care Organizations (ACOs) are a core component of the Affordable Care Act and a framework by which Partners HealthCare delivers value-based care. In an ACO, Partners-affiliated doctors, hospitals, and other health care providers, come together to provide coordinated, high quality care to our patients.
ACOs have agreements with insurance companies to provide special services and care coordination for certain patient populations. These agreements set performance standards for quality and spending, which in turn, provides either shared-savings incentives or penalties based on performance.
Since 2012, Partners has entered into new contracts with all the major insurers including the Centers for Medicare & Medicaid Services (CMS), commercial payers and MassHealth.
Testing The Waters With Medicare
The Medicare population are those with federal health insurance, who are typically aged 65 or older or certain younger people with specific conditions or disabilities.
After the adoption of the Affordable Care Act (ACA) in 2010, CMS created the CMS Innovation Center. The Innovation Center worked to test and evaluate different payment models with help from 32 health care systems nationwide, including Partners HealthCare. The feedback on this “Pioneer ACO Model” ultimately shaped the creation of a more formal ACO adoption moving forward. After five years (2012-2016) in the Medicare Pioneer ACO Model, Partners showed savings of $38 million.
In 2017, Partners became a Next Generation Medicare ACO. With an overall quality score of 94.5%, Partners is among the best ACOs in the nation. Programs aimed at our Medicare patients include our High-Risk Care Management program and our suite of Care Continuum programs.
Supporting The Medicaid Expansion
Medicaid patients (MassHealth) are those enrolled in a joint state and federal insurance program for individuals and families with limited resources.
When the ACA passed, it also heralded a Medicaid expansion. In Massachusetts, MassHealth went from covering a quarter of the population to a third of the population. To create a more sustainable health care ecosystem, Massachusetts has distributed and shared the responsibility, accountability, and financial risk for many of its patients by adapting the ACO model. Our MassHealth ACO (Partners HealthCare Choice) launched in March 2018.
At Partners, we work to address both medical needs as well as social determinants of health: where people are born, grow, live, work, and age. These factors play a major role in impacting health. Our current suite of programs help screen for social challenges, connect patients with appropriate services, and leverage existing community-based programs.
OUR LARGEST PATIENT POPULATION: COMMERCIAL
Our largest Accountable Care patient population is covered by “commercial payers”—insurance people pay for independently or through their work. In general, these patients are not as sick or as complex as those covered by Medicare or Medicaid. Our goal for these patients is to effectively deliver preventative care and increase access to:
- Advanced primary care settings;
- Integrated behavioral health offerings;
- Digital health tools;
- Educational resources;
- Guidance on elective procedures.
To measure our success in these risk contracts, we use innovative quality metrics. Partners Population Health programs are available to all commercial patients; and if members do have complex, chronic conditions their providers can leverage offerings like high-risk care management for more tailored care interventions.