BN: NY's First Medicaid ACO to Open in Buffalo

NYAPRS Note: We are in the midst of the historic move from fee for service (where payments tied to visits), to value based reimbursement, where payments are tied to "patient outcomes" and where providers can make more by sharing in the savings generated from more efficient care.In one VBP strategy, providers join together in a new business entity called an Accountable Care Organization that creates a network designed to reward high performing providers with increased profits. While Medicare ACOs have existed for some time, a Medicaid ACO focused on serving Medicaid beneficiaries with multiple serious and ongoing conditions is being launched for the first time in our state in Buffalo, essentially creating a medically run profit making iteration of our health homes. Two concerns that NYAPRS and our colleagues have raised with state officials: we must both ensure that providers don't withhold services to increase profits and ensure that recovery-focused providers play prominent roles within these new Medicaid ACO networks. Stay tuned...

State's First 'Accountable Care Organization' for Medicaid Patients to Open in Buffalo By Stephen T. Watson Buffalo News September 9, 2016

An organization of doctors in Buffalo - the first of its kind in the state - will provide its patients with higher-quality, more-efficient care to better manage their chronic diseases while keeping more of them out of the hospital, the group's founders said Thursday.

Since the passage of the Affordable Care Act, doctors, hospitals and other health care providers have formed groups known as accountable care organizations to better coordinate the care provided to their Medicare patients. The aim: Avoid unnecessary tests and procedures, improve outcomes and save money.

Now, state regulators have agreed to let a Buffalo health care network form the first accountable care organization in New York State to serve Medicaid and commercial insurance patients.

The founders of the Greater Buffalo United Accountable Care Organization say its physicians will deliver care to their patients under a system that rewards innovation and promotes quality over quantity.

"We're radical - we're probably going to be the Uber for health care," Dr. Raul Vazquez, the local organization's president and CEO, said at a news conference Thursday to announce the state Health Department's approval of the organization.

The 320 or so primary care physicians and specialists in the local organization handle about 65,000 patients. Major practice groups that have agreed to join include Western New York MRI, MASH Urgent Care, WNY Medical, CCS Healthcare and Dent Neurologic Institute.

The first commercial insurer to join the local organization is YourCare Health Plan, the regional, not-for-profit health plan that serves Western New Yorkers who are eligible for government-sponsored coverage.

Organizers expect the local organization, which is part of the Greater Buffalo United Accountable Healthcare Network, to begin operations next month.

"We are very excited and ready to begin this journey," said Ralph Hernandez, the former Buffalo School Board member who serves as executive director of the local organization.

Accountable care organizations are an innovation of federal health care reform.

The idea, according to the Centers for Medicare and Medicaid Services, is to deliver the right level of care, at the right time, particularly for chronically ill patients, while avoiding unnecessary testing and duplicative services.

It's part of the shift from the traditional fee-for-service model, where physicians or hospitals are paid for each procedure or test they perform, to models of bundled payments or those where payments are tied to quality measures and outcomes.

The organizations are created to lower the cost of care, too. Most of the organizations serve Medicare patients, and the participating providers share in any savings with the federal government.

Patients don't join the organization on their own, but they come along with their doctors, Hernandez said. The organization will provide resources to its member doctors to better serve and manage the needs of those patients, the founders said.

The providers must meet quality standards that focus on illness prevention and management of chronic diseases. They receive incentives for keeping their patients healthy while avoiding emergency room visits and inpatient hospital stays, officials said.

For the organization to work, the participating providers must talk with each other. Sharing patient information through a unified system of electronic health records is key, said Dr. Joseph Serghany, a radiologist and president of Western New York MRI, one of the participating provider groups.

Serghany also praised Vazquez's business sense. The local organization is a product of the Greater Buffalo United Accountable Healthcare Network, a medical services provider owned by Vazquez and eight physician practices. It was formed under the Affordable Care Act to work with low-income, Medicaid patients who have at least two chronic illnesses.

The network is consolidating its administrative and health care workers in a $5 million building now under construction on the city's West Side, a project that represents one of the largest investments in that neighborhood in the last 25 years.

The company, one of the region's largest minority-owned businesses, has 160 employees and will grow to 260 employees when the facility opens next year.

"This group, this business, is doing huge things in the City of Buffalo that will have a transformative effect on the quality of life in this city," Mayor Byron W. Brown said.