A prominent group of health centers in the North Bay has applied to form what is known under the new federal health law as an "accountable care organization" serving thousands of Medicare patients that, if approved, would be one of the first of its kind in the nation.
Santa Rosa Community Health Centers, Petaluma Health Center, West County Health Centers, Alliance Medical Center in Healdsburg, Clinic Ole in Napa County and Coastal Health Alliance in Marin County are all combining efforts to form the Redwood Community Care Organization.
"In terms of an (accountable care organization) that's based on (federally qualified health centers), I've been unable to find any," said Mark Knight, a health care consultant in Santa Rosa who is advising the new organization on expanding its provider network. "This may be one of the first in the country. If it's not the first, it's one of a very small number."
[caption id="attachment_71370" align="alignright" width="200"] Naomi Fuchs[/caption]
The health centers hope to receive approval for the accountable care organization, an initiative overseen by the Centers for Medicare and Medicaid that was established under ObamaCare, by January, according to Naomi Fuchs, chief executive officer of Santa Rosa Community Health Centers. She will also serve as CEO of the newly formed organization, also known as an ACO.
Under the ACO program by Medicare, health care providers and payers are encouraged to better coordinate care, hoping to achieve the so-called "triple aim" of improving quality of care, improving patient experience and reducing costs, officials said.
"All of our initiatives are about the triple aim," Ms. Fuchs said. "Better care, better health and lower costs. Our emphasis is on achieving that goal through improved coordinated care. We think a lot of the excess cost is because there isn't enough coordination between hospitals, the medical homes and health centers."
The group of health centers hopes to take advantage Medicare's "shared-savings" program, which financially rewards heath care providers who meet certain criteria. It's one of three types of ACOs that "facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service beneficiaries and reduce unnecessary costs," according to a description by CMS.
It differs from other ACOs that often take on more risk, such as the Pioneer ACO Model, according to Mr. Knight. In addition, he said, it's being carried out by mostly primary care providers, instead of multi-specialty groups and hospitals that have made up much of newly formed ACOs.
"This only has upside potential," Mr. Knight said, noting that after the three-year initial period, the ACO might have to assume more risk.
The Redwood Community Care Organization is also different from most ACOs in that it's one of only a few driven by federally qualified centers. Typically, ACOs throughout the state have involved either physician groups or independent physician associations partnering with hospitals and an insurance product, such as the Meritage Medical Network, which was approved as the North Bay's first ACO earlier this year.
The new organization will serve approximately 6,000 Medicare patients across the three counties, according to Kathie Powell, CEO of the Petaluma Health Center, who will serve as the ACO's compliance officer.
Ms. Powell said the group of centers, each already a part of the Redwood Community Health Coalition, viewed the formation of an ACO as an opportunity to both save money and, eventually, increase services with any savings.