Many of us have now heard of or formed opinions on the roll out of the Patient Protection and Affordable Care Act, commonly known as ObamaCare.  Doubt has been cast over the benefits of ObamaCare, particularly among those in the community who had to purchase an ObamaCare health care plan earlier this year.  However, many people are not aware of one of the important aspects of ObamaCare , namely the creation of the Medicare Shared Savings Program (MSSP) which promotes the integration of general practitioners, specialists and a hospital into an “organized system of care” or “accountable care organization” (ACO.)  Locally, an ACO called the Northern Michigan Health Network (NMHN) has had been launched in Traverse City by Northern Physicians Organization (NPO), a partnership of more than 230 Northern Michigan primary care physicians and specialists.  NMHN is a physician-led ACO which facilitates local health care providers working together to provide patients the best level of care without any unnecessary duplication of services.  The ultimate benefit of this type of organization is its goal of reducing health care costs, while providing patients a comparable or indeed superior level of care than that which they had prior to the implementation of the Obamacare.  The program will benefit both non-Medicare patients as well as Medicare patients. 

Nationally, Medicare is dramatically expanding its use of ACOs.  In May 2014, there were 338 ACO’s participating in its Medicare Shared Savings Plan. Insurers like Aetna and Blue Cross Blue Shield are also rapidly expanding similar ACO programs by selling price-guaranteed insurance plans to small and medium-sized businesses or providing bonuses to ACOs that can lower expenses.

Price controls and limited payments may sound like a resurrection of the often maligned managed care system that began in the 1990’s, where health maintenance organizations (HMOs) earned a reputation for denying care and producing unhappy patients.  However, the new ACO model is focused on primary care and allows a patient to continue to choose a physician.

As a patient, you do not need to sign up to participate in this system.  If your healthcare provider(s) are a part of Northern Michigan Health Network, you’re already experiencing the benefits of this collaboration. However, patients can choose whether or not they allow NMHN to see their Medicare claims.  As an NMHN participant, your doctor, specialist and hospital will communicate with each other, and partner with you in making health care decisions.  As a patient, you will benefit from not having to fill out medical history paper work because your doctors may already have this information in an electronic health record.  You’ll likely have fewer repeated medical tests because your doctors and hospitals will share information and coordinate your care.  Your doctors will use data from Medicare to help improve how they provide care. For example, your doctors will get your medical information from Medicare to help them to know your medical history, including your medical conditions, prescriptions, and visits to the doctor, and give you the right care at the right time in the right setting.  The privacy and security of your medical information is at all times protected by federal law.

There are, however, large start-up costs for implementing new technology for sharing data between different groups of healthcare practitioners as well as possible time expenditures spent resolving technology difficulties.  While data sharing may improve medical outcomes, insurers could lower payments to providers as they gain insight into the true cost of healthcare.  An insurer could ultimately decide to reduce bonuses or instead begin paying flat-fee reimbursements per patient, regardless of the illness.

The structure of the ACO will also determine how the lump sum payment from insurers will be divided among the various professionals. While providers are still responsible for treating patients, now the financial risk of that treatment may fall upon the providers themselves instead of insurance companies, depending on the reimbursement model.

The roll out and implementation of the MSSP by NMHN will ultimately benefit patients, doctors and the local community alike.  While Medicare is implementing an essentially untested ACO model and private insurers are following along, NMHN is looking towards the future of healthcare in the local community by balancing cost, access, quality and choice in a bid to make the American patient happy.