Three Arkansas-based health care provider groups and a coalition of clinics in Arkansas, Maryland and New York are among the organizations that have been approved to join a program that allows them to earn rewards for lowering health care costs, a federal agency announced.
In addition, the St. Louis-based Mercy health system, which owns six Arkansas hospitals, will expand its participation in the Medicare Shared Savings Program to include all the system's clinics in western and northwestern Arkansas -- about 40 in all.
Starting Jan. 1, the provider groups will join hundreds of so-called accountable-care organizations across the country participating in the program, which was created as part of the 2010 federal health care overhaul law.
The Fort Smith Physicians Alliance, which includes about two dozen clinics, joined the program in 2013.
The Arkansas Health Network, owned by the CHI St. Vincent Health System, and Accountable Care LLC, formed by the Medical Associates of Northwest Arkansas, joined the program at the beginning of this year.
The program requires participating organizations to serve at least 5,000 Medicare patients and meet certain benchmarks for health care quality.
Provider groups that reduce the cost of their Medicare patients' medical services below a certain threshold will receive payments equal to a percentage of the savings to the federal government.
In exchange for a potentially higher percentage of the "shared savings," the organizations also can opt to be responsible for some of the excess cost if the patients' care exceeds the acceptable range. None of the Arkansas networks chose that option.
Under the umbrella of the Arkansas High Performance Network, a Fort Smith group of companies formed three of the provider coalitions that will join the program next month.
Those provider groups include a system of clinics owned by a northeast Arkansas hospital, 10 of the state's 12 community health centers and about 150 independent practices across the state, Nick Smith, the umbrella group's owner and chief executive, said.
He declined to name the providers, saying they hadn't given him permission. He said they are all across the state, serving about 100,000 Medicare patients.
His company will provide services such as helping the practices identify patients at high risk of needing expensive medical care, offering phone-based "health coaching" for some patients and giving the practices information about specialists, he said.
In return, the Arkansas High Performance Network will get less than half of any savings earned through the program. Practices with better performance will earn a higher percentage of the savings, Smith said.
Some of the practices also are participating in a similar, Medicaid-led program that offers rewards for keeping costs low. The provider groups also are exploring agreements with private insurers, Smith said.
Another accountable-care organization, formed by Bethesda, Md.-based Aledade Inc., includes four Arkansas clinics -- in Mountain View, Melbourne, Sheridan and Hot Springs -- and a similar number of clinics in Maryland and New York, said Mat Kendall, Aledade's executive vice president for provider networks.
The company is analyzing data for the clinics and helping them share information and improve their practices, Kendall said. In return, the company will get 40 percent of any shared savings awarded.
The company has hired the nonprofit Arkansas Foundation for Medical Care to help with the effort in the state.
The company, which also formed an accountable-care organization with clinics in Delaware, Maryland and Pennsylvania, was founded by Farzad Mostashari, the former coordinator for health information technology at the U.S. Department of Health and Human Services.
Kendall, who worked under Mostashari at the department, said the company decided to work in Arkansas in part because of other health policy initiatives in the state and "the quality of work that was being done," especially by the Arkansas Foundation for Medical Care.
The Mercy health system, which owns hospitals in Berryville, Fort Smith, Ozark, Paris, Rogers and Waldron, began participating in the Shared Savings Program last year with an accountable-care organization that included clinics in southern Missouri and northern Arkansas.
Starting in January, the rest of the system's clinics, including those in western and northwestern Arkansas; St. Louis; Joplin, Mo.; and Oklahoma will begin participating as members of a separate accountable-care organization.
The health system views reducing costs as part of its mission, said Jim Rogers, Mercy system's vice president for adult primary care.
Comparisons of health care spending in the United States and in other countries shows that "we're not getting the same value for our health care expense that we should," Rogers said.
"It's time that we start forcing ourselves to pay more attention to it and working with our patients to drive those costs lower," he said.
Metro on 12/24/2014