Nearly a year after becoming the North Bay's first accountable care organization under the federal health care overhaul, Meritage Medical Network is reporting positive, albeit preliminary, results on readmission rates and improved outcomes.
The ACO, which received approval from the Centers for Medicare and Medicaid in January 2013, is known as the Meritage Care Transition Model. Established under the Affordable Care Act, the ACO initiative seeks to reduce hospital readmissions among Medicare beneficiaries by way of financial incentives for providers and hospitals, leading to more coordinated care and thus less costly, often duplicative care.
To that end, at Marin General Hospital between May 1 and Aug. 31 of this year, a total of 35 patients completed the Care Transitions Program, with only one patient being readmitted to the hospital within 30 days. That equals a readmission rate among Medicare beneficiaries of 2 percent, compared to a national Medicare hospital readmission rate of 18 percent.
"Managing transitions and avoiding preventable admissions is one of our goals," said Andrea Kmetz, RN, director of care management for Novato-based Meritage Medical Network. "We have a trained staff of RN case manager who visit patients in the hospital before discharge, visit them at home within 48 hours of discharge, and sit down and make sure they understand their medications, and that they get the appointment for follow-up care that they need.
"Every patient gets a home visit, which is something that is unique among other ACOs," she added. "Everyone is seen in their own home."
The entire ACO population, across Marin, Sonoma and Napa counties, includes about 16,000 fee-for-service Medicare patients seen by about 250 physicians, excluding Medicare Advantage beneficiaries.
While the data so far is promising, Ms. Kmetz said Meritage Medical Network won't know the full scale of effectiveness until about year or so, given the relative newness of the ACO model.
Still, it's in everyone's interest to stem costly hospital readmission rates among a population that is often elderly but, with the right approach, is manageable, Ms. Kmetz said.
"The hospitals are facing a penalty if their readmission rate is higher than the norm, so we're going to help the hospitals avoid that penalty," she said, referring to an element of the Affordable Care Act known as value-based purchasing, which will reward or penalize hospitals on how well they match up with others in the industry and how well they improve over time.
The Meritage Care Transition Model ACO is taking part in the "shared-savings" model, one of three models developed by CMS for ACOs. The medical network is looking to expand the care transition model outside of its ACO population. The network has some 700 physicians across the North Bay and works with numerous hospitals, among them: Marin General, Petaluma Valley, Sonoma Valley, Palm Drive and Santa Rosa Memorial.***
Meritage Medical Network was also recently named as a top performer by the Integrated Healthcare Associations, one of 45 physician organizations to earn the distinction and one of three in the North Bay.
Out of nearly 200 physician organizations, the 45 top performers achieved the highest overall benchmark for quality in 2012 based on the IHA statewide Pay for Performance program measures.
Awards are based on performance in three pay for performance quality measurement domains: meaningful use of health information technology, patient experience, and clinical measures that include priority conditions such as cardiovascular, diabetes, musculoskeletal, respiratory, and prevention.