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Spotlight on Innovation: Centura Health Implements Medicare ACO

Colorado’s Centura Health was one of a handful of organizations across the country to begin implementing a Medicare Accountable Care Organization (ACO) last month. Centura’s program, Colorado Accountable Care, is the first Colorado Medicare Shared Savings ACO approved by the Center for Medicare & Medicaid Innovation. Colorado's Physician Health Partners began implementing the Medicare Pioneer ACO last year. The Centura program is estimated to improve care and reduce health care spending for approximately 8300 Medicare beneficiaries being seen by Centura’s 13 hospitals and 460 Centura-employed physicians.

The primary goal of Colorado Accountable Care is improving and maintaining population health by providing a high quality continuum of care. As part of the Medicare ACO program, Centura’s facilities and providers will be measured on 33 separate quality indicators to ensure appropriate, timely and well-coordinated care. This “Patient-Centered Medical Home” approach to population health management is something Centura’s Clinical Integration Network, their ACO for commercial/self-funded payers, has been working on for several years.

John Suits, Executive Director of Colorado Health Neighborhoods and Centura’s ACO lead, says that by the end of 2015 they aim to have 150,000 Coloradans covered under one of Centura’s ACOs. They currently have 600 physicians and several rural affiliate hospitals signed on to participate in the non-Medicare ACO. For the first year, inclusion in the Medicare ACO is limited to Centura facilities and employed providers only, however, the organization intends to include non-employed providers and affiliate hospitals in years two and three of the program.

If successful in reducing the cost to provide care for Medicare patients, Colorado Accountable Care can share in the savings with Medicare. To be eligible for revenue sharing in year one, Centura is required to report the 33 quality measures to CMS. By year three, accountability increases and revenue sharing will be determined based on how the ACO providers actually perform on the measures compared to established benchmarks.  “Our engaged providers are key to the success of the ACO since they are on the front line managing the medical neighborhood and making sure their patients don’t fall through the cracks,” said Suits. As an additional incentive for the care management activities that aren’t traditionally paid for under the fee-for-service model, Centura will share 70 percent of all Medicare savings with their ACO providers. Providers are very active in Colorado Accountable Care, with both the board and sub-boards comprised of physicians.

Suits said Colorado Accountable Care will likely track many more quality metrics than the 33 established by CMS in order to achieve cost savings and improved population health. While many of the metrics hit the mark to improve care, Suits indicated they won’t be enough for all of Centura’s patients. “Our patient demographics vary so widely across our multiple facilities that we owe it to our patients to go above and beyond the established measures to make sure their specific needs are being met.”

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