Health Care: Meritage Medical officially seeks ACO status

The Meritage Medical Network, formerly known as the Marin-Sonoma IPA, has officially made known its plan to earn accountable care organization, or ACO, designation by the Centers for Medicare and Medicaid under the Affordable Care Act of 2010.

The designation, if granted, would afford the physicians network bonuses and better reimbursement rates for providing coordinated care for Medicare beneficiaries.

Writing in Sonoma County Medical Association's magazine Sonoma Medicine, Mark Wexman, chairman of the board for the 600-plus member network that includes physicians in Marin, Sonoma and now Napa counties, said the ACO model will be a key step in a post-reform health care environment, particularly for "non-Kaiser patient care delivery."

Kaiser Permanente's structure very closely resembles that of the new ACO structure, which typically includes a provider or hospital working more closely with an HMO to ensure less redundant care. While ACOs officially fall under the purview of CMS, much of the private sector is aligning in similar fashion, with the most recent North Bay example of Western Health Advantage, a Sacramento-based HMO, expanding into the North Bay, where it will work with the Meritage network as well as all of the region's non-Kaiser and non-Sutter Health affiliated hospitals.

Given the aging population in the three North Bay counties, the Medicare savings could be significant, according to Dr. Wexman, a Larkspur cardiologist.

Across Marin, Sonoma and Napa counties, the Medicare population is roughly 136,000 people, Dr. Wexman said. Of those, 45 percent are already covered by Kaiser, leaving about 75,000 Medicare recipients remaining for Mertiage's network.

Dr. Wexman explained that if the physicians network could reduce medical inflation from the predicted 8 percent to 4 percent, then half of the savings, or 2 percent, could go toward physician or hospital reimbursement and other community care processes.

The average Medicare patient uses roughly $12,000 per year in services, meaning total spending on non-Kaiser Medicare patients across the three counties is roughly $900 million. A 4 percent reduction in inflation could translate to a shared $18 million in savings per year, according to Dr. Wexman.

The ACO structure "aligns the expense of an innovation in health care delivery with the economic incentive of better reimbursement for ACO providers who can demonstrate better care outcomes and patient satisfaction and 'bend the cost curve,'" Dr. Wexman wrote.

The physician's network filed for the designation recently and expects a response from CMS by early 2013.***

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