HARRISBURG - River Health Accountable Care Organization LLC has been selected as one of 123 new Accountable Care Organizations (ACOs) in Medicare, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality, coordinated care across the United States, according to Kathleen Sebelius, health and human services secretary.
River Health ACO LLC, which includes PinnacleHealth System, Susquehanna Health, Family Practice Centers, Annville Family Medicine, Laurel Health Centers and Susquehanna Community Health and Dental Center, was formed on April 15, 2013, to improve the cost, quality, access and patient experience for residents of central Pennsylvania. Effective Jan. 1, River Health ACO will work with CMS to provide Medicare beneficiaries with high-quality care while reducing the rate of growth in Medicare expenditures. This will be accomplished by focusing more attention on health and wellness, providing additional services to patients with chronic disease conditions and providing better coordination of care.
"PinnacleHealth has achieved an important milestone in our journey to move our health care delivery system to an Accountable Care Organization (ACO) model. We are putting the patient at the center of care, helping them to navigate the health care system so they get the right care, from the right provider, at the right time and in the right place," said Michael A. Young, president and CEO of PinnacleHealth System.
"By joining together our hospitals, doctors and other health care providers, we are creating a new system to provide high quality care to our patients. Patients benefit because our doctors and providers will build on the already strong connections we have with each other to help patients get the best care and improve their overall well-being," said Steven P. Johnson, president and CEO of Susquehanna Health.
Medicare beneficiaries who fall under the River Health ACO will be notified with letters from their physicians. Doctors and Medicare coverage will not change. Patients can still see any doctors who are in Medicare, even those who are not members of the River Health ACO. However, by choosing physician participating in the River Health ACO, they will receive more coordinated care.
The physicians and staff of River Health ACO will work with Medicare beneficiaries who have complex chronic conditions, such as diabetes or congestive heart failure, to provide care management between medical visits. For patients who are well, wellness information and activities, such as screenings and immunizations, will help prevent or detect illness before it becomes serious.
Doctors, hospitals and health care providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth.
ACOs have been established, serving more than 5.3 million Americans with Medicare.
Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO.
ACOs share with Medicare any savings generated from lowering the growth in health care costs when they meet standards for high quality care.
The ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely.
The Centers for Medicare and Medicaid Services (CMS) evaluates ACO quality performance using 33 quality measures on patient and caregiver experience of care, care coordination and patient safety, appropriate use of preventive health services and improved care for at-risk populations.
The new ACOs include a diverse cross-section of health care providers across the country including providers delivering care in under-served areas. More than half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries.
About one in five ACOs include community health centers, rural health clinics and critical access hospitals that serve low-income and rural communities.
More information about the Shared Savings Program is available at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/
For a list of the 123 new ACOs announced, visit: www.cms.gov /Medicare/Medicare-Fee-for-Ser vice-Payment/sharedsavingsprog ram/Downloads/2014-ACO-Con tacts-Directory.pdf.