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5 Ill. health networks get Medicare ACO nod

Published: Friday, Jan. 11, 2013 5:30 a.m. CST

CHICAGO – The largest Catholic health system in Illinois has gained approval from the federal government to run a so-called “accountable care organization,” part of a program aimed at controlling costs and improving quality in Medicare.

Presence Health, formed in 2011 by the merger of Provena Health and Resurrection Health Care, will operate one of the five newly minted ACOs in Illinois announced Thursday by U.S. Health and Human Services Secretary Kathleen Sebelius.

Nationally, 106 new ACOs were announced, bringing the U.S. total to more than 250, officials said. That means 4 million Medicare beneficiaries will be assigned to an ACO.

The government estimates the ACOs could save $940 million over four years by preventing unneeded care and keeping patients healthier. Each ACO must manage the care for at least 5,000 Medicare beneficiaries for three years.

The ACOs will share cost savings with Medicare if they can keep quality high while reducing unnecessary spending. ACOs are part of President Barack Obama’s national health care overhaul.

“We didn’t want to just grow as we merged, but to transform,” Dr. Richard Ferrans told journalists during a conference call. He will head the Presence Health ACO, called Medicare Value Partners. Presence Health has 12 hospitals.

Patients assigned to an ACO can decline to share their health information with the program. The data sharing is meant to improve the quality of care by giving doctors a complete picture of each patient’s interactions with the health care system.

Ferrans said data sharing will allow the ACO to identify patients with diabetes, for example, who haven’t seen a primary care doctor in more than a year. “We can reach out and get them to a primary care physician,” he said. That will improve patient health and prevent costly complications.

The other four newly approved ACOs in Illinois are Arlington Heights-based Alexian Brothers, Champaign-based Christie Clinic, Mishawaka, Ind.-based Franciscan Union and Independent Physicians ACO of Chicago.

Dr. John Venetos of Independent Physicians ACO of Chicago said it was formed by 125 doctors with no hospitals directly involved. The organization will coordinate care for 15,000 patients, Venetos said. Spending will be reined in by closely watching the care of patients after each hospital stay to avoid unneeded return trips, he said.

“Within a week of discharge, they are going to be seen in primary care physicians’ office,” Venetos said. “If we can’t get them into the office, our intent is to have somebody go to the [patient’s] house.”

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