One of our Community Health care managers once described her job as being the glue that holds people together, acting as the lifeline to resources and services, keeping patients safe and interpreting a complicated health care system. Care managers and providers are at the heart of Accountable Care Organizations (ACO), a concept developed in the Affordable Care Act to reduce health care costs by encouraging health care providers to form networks enabling them to coordinate patient care.
At Community Health, we recently congratulated five of our care managers, also known as case managers, who received national certification for the achievements and skill level they have attained to continue the challenging work they encounter each day managing the care of hundreds of patients in our network. Coordinating and managing care in our current, often complex, system takes skill, experience and caring.
I have supported the ACO model since its inception because it makes sense, calling for better and more comprehensive patient care by coordinating treatments and medications, sharing patient medical data and having providers work together to determine the best path for a patient’s health care.
In 2013, OneCare Vermont (OneCare) was established as a Medicare ACO with the goal to “improve the health of Vermonters and lower health care costs.” To accomplish this, OneCare “partners with health insurance companies, hospitals, independent medical practices and community collaborators to offer programs that pay for positive outcomes and health care activities.”
As a member of OneCare, Community Health continuously sees patient outcomes improve as a result of the ACO and OneCare programs. Health care providers pool resources and expertise and share health care data and information. I see the results every day, as the care management system ensures patients receive the opportunity to become healthier and stay healthy through the coordination and collaboration of providers, care managers and the community.
At Community Health, our mission has been to provide affordable high-quality care through access to primary care, managing chronic illnesses, and by staying in sync with the needs of our population. The ACO system allows us to deliver the very best care to patients in a primary care setting that considers all of the clinical and non-clinical needs of our community, including dental, behavioral health, pediatric, pharmacy services and social work, in conjunction with community resources to address every-day life problems like unemployment, homelessness and food insecurity.
The problem with most health systems today is that patients are getting each part of their health care separately. In Vermont, the benefits of managed care have been recognized, where patients receive comprehensive care to address chronic illness and to care for the most vulnerable populations. A 2020 case study of OneCare showed the number of patients who are taking advantage of managed care in Vermont has increased by 91% in two years. From 2018 to September 2020, the number of managed care patients increased from 504 to 5,470 and growing. OneCare during this time period reported participants in the ACO showed an increase in primary care engagement, as well as a reduction in trips to the emergency department.
Part of the cost of operating the ACO is support and maintenance of a secure communications and collaboration platform, regional collaboratives, targeted technical assistance and training, and payments. The ACO and Medicare provide financial incentives when these goals and quality measures are reached by its members.
Community Health is among the 14 hospitals, 133 primary care practices, 276 specialty care practices, nine federally qualified health centers, 27 skilled nursing facilities, 10 home health agencies, 11 mental health and substance abuse agencies, and five Area Agencies on Aging (AAAs) across the state that are members of OneCare. Vermont’s ACO is leading the way to a new approach to health care by starting to make the process more manageable and understandable to those who need it most.
Join me in supporting this federally sponsored program that is helping to bring better health care solutions to our state.
Don Reuther is Community Health CEO.