Significant Potential for ACOs to Improve Care, Lower Costs for Dual Eligibles

Monday, September 17th, 2012
This post was written by Cheryl Miller

Three cost-saving programs make headlines this week; the first, a new study by Dartmouth researchers showing that ACOs can slow the cost of treating dual eligibles. The results from a similar payment reform model, Medicare’s Physician Group Practice Demonstration (PGPD), showed that the PGPD trimmed the cost of serving this part of the population $532 annually (after adjustment for inflation), almost five times more than the $114 per beneficiary savings generated in the general Medicare population primarily by reducing acute care hospitalizations and readmissions.

In another cost-saving exercise, using data from nearly 250,000 U.S. physicians serving commercially insured patients nationwide, a new report from UnitedHealth Group’s Center for Health Reform & Modernization shows that high-quality medical care can be about 14 percent more affordable on average, with significant local variations. The report examines care quality and medical costs for episodes of care and emphasizes four strategies to accelerate care provider payment reform to improve patient care.

More than $34 million in healthcare costs was saved with a nationwide patient safety project aimed at reducing the rate of central line-associated bloodstream infections (CLABSIs) in ICUs. The project, funded and reported by the AHRQ, used a customizable toolkit program called the Comprehensive Unit-based Safety Program (CUSP) to help doctors, nurses, and other members of the clinical team understand how to identify safety problems. Overall, it reduced CLABSIs in ICUs by 40 percent, prevented more than 2,000 CLABSIs, and saved more than 500 lives.

Contrary to these cost-savings measures, the federal Pre-Existing Condition Insurance Plan, the high-risk health insurance pool established by the ACA, is succeeding as a transition program but failing as a long-term solution given the cost of running it, according to a new Commonwealth Fund report. Currently, the plan provides coverage options for people with pre-existing health conditions until they are eligible to purchase insurance through the new state exchanges in 2014, with much of their costs subsidized. But the program’s high costs and low enrollment numbers make it untenable for the long term. One reason: the federal high risk pool often attracts the sickest whose premiums are capped at certain levels, and their premiums fall short of paying for their treatment.

And lastly, don’t forget to take our Population Health Management in 2012 survey. Improvement of population health is a tenet of the Institute for Healthcare Improvement’s Triple Aim, along with enhancing the patient experience and curbing per capita health costs. Describe your organization’s efforts in population health management by September 30 and you will be e-mailed a free executive summary of survey results once it is compiled. Your responses will be kept strictly confidential.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

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