percentage of patients who received a flu vaccine, were screened for being a fall risk and whose diabetes was
under control. There’s a lot of green, indicating that the ACO exceeded its target in those areas.
The ACO sets targets for meeting quality measures. Every month, staff report whether providers are meeting
the quality goals.
“If not, we fine tune the processes,” Kane said. “If we focus, the numbers get better.”
Reducing utilization has been a slower progress.
In 2013, the readmission rate for heart attacks among
Medicare patients was 14.8 percent. In 2014, it
dropped to 10.8 percent. So far, in 2015, it’s 13.9
percent. The target is 9.5 percent, Kane said.
The readmission rate for all causes is better. In 2013,
it was 13.6 percent; in 2014, 12.7 percent, and in
2015, it was 11.2 percent.
To help prevent patients from being readmitted to
the hospital, each patient is given a comprehensive
discharge plan before being released. Someone
checks to ensure that the patient is taking the right
medications. After the patient returns home, a
clinical staff member follows up to make sure the
patient visits his primary care doctor and has filled
any prescriptions.
The ACO, because of its relationship with insurance
companies, receives management fees to help pay for
the follow-up care.
“We’re making progress in reimbursement,” Kane
said.
Kane is part of a group of stakeholders that are working with the state to reform the healthcare payment system.
“The biggest challenge is to institute a workable new payment methodology with all payers at the same time,”
he said. Having each insurer pay providers differently would create administrative nightmares.
“It harkens back to the lack of standards in the healthcare industry,” he said, explaining that currently there is
no agreement among insurers on the appropriate age and frequency to have mammograms or how often to get
colonoscopies. Those standards need to be established so healthcare providers know what their goals are.
Central Maine Healthcare ACO
Denise Brooks, RN, high-risk care coordinator, talks with a patient.
