Dive Brief:
- Eastern Maine Healthcare Systems has partnered with the state's largest health insurer, Anthem Blue Cross and Blue Shield, to create an accountable care organization serving 40,000 Anthem beneficiaries. The ACO, which also involves participants in other parts of the state, involves a total of 15 hospitals and 405 primary care providers from 114 practices.
- As part of the deal, EMHS has agreed to forgo any cost increases for services delivered to the Anthem policyholders, a promise that could put millions of dollars at stake for the health system.
- Under the terms of the ACO agreement, providers will work to see that patients get preventive care and manage chronic illnesses. If the providers don't cut costs or miss quality targets, they'll suffer financially.
Dive Insight:
This is not the first time EMHS has been involved in an ACO, and last time, it didn't go so well. Three years ago, the health system was chosen to participate in the Medicare Pioneer ACO program, and while the first year went well, EMHS was fined $3 million in 2013 for failing to meet its spending target. However, EMHS did learn some things during those years, and its nurse care coordination program received accreditation from a high-profile national quality organization. (EMHS remains in the Pioneer program despite its 2013 losses.)
This time around, EMHS executives admit that they feel "a lot of anxiety" about committing to existing pricing and meeting ACO goals, but apparently feel it's worth the risk. One asset it can rely on is its nurse coordination program, which helps patients make appointments, manage medications and follow doctors' orders. But the health system will clearly have to play its cards very carefully if it is to benefit from participating in the accountable care organization, which is the largest commercial ACO deal in the state.