The Greater Buffalo United Accountable Care Organization (GBUACO) is the first Medicaid accountable care organization (ACO) established in New York state. GBUACO is a pioneer in the movement from a treatment system – a system that responds when someone is ill – to a prevention system that focuses on keeping people healthy.
GBUACO operates a value-based payment system for the providers in its network, emphasizing the Triple Aim of Health Care – improved population health, improved patient care, and decreased costs. Value-based care models center on patient outcomes – outcomes based on clearly defined metrics that demonstrate how the providers within the ACO network are doing in keeping patients healthy. Value-based payments compensate providers based on the quality versus the quantity of services rendered. As a result, expensive duplicative medical tests are reduced, as are unneeded, costly and inconvenient repeat office visits.
Some of the health metrics used to measure quality in a Medicaid accountable care organization include:
- Behavioral health medication management effectiveness
- Nephropathy treatment of diabetic patients
- Sexually transmitted infection (STI or STD) screening rates
- Breast cancer screening rates
- Emergency room usage
Value-based Payment Model
A Medicaid ACO’s web of professionals is compensated under a value-based payment (VBP) system. Under VBP, providers are incentivized for keeping their patients healthy. Through care coordination, costly duplicative medical tests are reduced. The value-based payment system is all about value not volume; quality not quantity. Under VBP shared savings, total spending is compared with a target: if the organization’s spending is below the target, it can share some of the difference as a bonus.
GBUACO member providers are eligible for bonuses/shared savings when they deliver care more efficiently as measured by specific metrics, for example:
- Glucose measurements for diabetic patients (HbA1c)
- Patient satisfaction ratings
- Hospital readmissions reduced
- Reduction in emergency department utilization
- Immunizations for children
- Alcohol and drug abuse screening
- Blood pressure rates
Benefits for the Patient
Medicaid ACOs give patients a more significant role in guiding their own care. The organizations provide open communication between physicians from different specialties within the same ACO to determine the best course of care. ACOs reduce medical history paperwork as records are stored in the practice’s electronic medical records or EMR.
ACOs relieve difficulties for patients including: transportation to appointments, conflicting treatments from different doctors, and confusion over being prescribed multiple medications.
More information on Medicaid ACOs can be found at the Center for Health Care Strategies website: www.chcs.org
Spotlight: Providers benefit in a Medicaid ACO
Providers who join a Medicaid ACO like GBUACO can benefit from their participation in multiple ways. An ACO is accountable to the well-being of the patient, but it is also a system that contributes growth to health care practices – enabling them maintain a high level of care that their patients need. Here are a few of the benefits on joining an ACO:
- Providers are given access to a larger population of patients enabling them to grow their practices
- Services that can be offered to the patient are broadened
- There is a pooling of expertise that can be provided to patients
- Co-branding and other marketing perks