Getting Paid For Quality and Efficiency
Central Maine Healthcare ACO
Although many services that hospitals offer their patients to reduce hospitalizations are not reimbursed, there
are some situations where providers work with payers to pay hospitals for the work they do to keep patients
healthy.
The Affordable Care Act encourages doctors, hospitals and other providers to form networks and become
eligible for bonuses when they deliver quality care more cost efficiently. These networks, called Accountable
Care Organizations (ACO), work with Medicare and other insurers to improve care and limit avoidable
spending.
Central Maine Healthcare (CMHC) has had something similar to an ACO for 20 years. What is now an ACO
was first formed as a Physician-Hospital Organization with similar goals, said Jim Kane, president of the
Central Maine ACO. It now has more than 46,000 patients. Of those, 16,000 are on Medicare and 18,000 are
insured through Anthem. The rest are insured through other insurance companies.
The ACO has 48 primary care practices with 240 primary care doctors. There are 280 specialists and four
hospitals: Central Maine Medical Center in Lewiston, Bridgton Hospital, Rumford Hospital and, until recently,
Parkview Adventist Medical Center in Brunswick, which coordinate care.
“We keep track of quality, utilization and costs,” Kane said, speaking from his office in the former Knapp Shoe
Factory in Lewiston.
The goal of the ACO is to improve the quality of care while reducing costs. Central Maine’s is still finding the
balance, but Kane knows where the ACO stands in all three areas: quality, utilization and cost.
“I’m positive it improves care,” he said. “I am positive that, overall, the quality has improved. We’re paying
attention to it.”
Kane refers to a large sheet of paper with red, yellow and green grids that tell him how the ACO is doing
in terms of quality for its Medicare patients. The measurements by which quality is evaluated include the
Central Maine Healthcare ACO
The goal of the ACO is improve the quality of care while
reducing costs.
