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Major area health-care providers receive new ACO Medicare designation

Sharon Hayes • Jan 10, 2013 at 11:30 AM

KINGSPORT — Some of the largest health-care providers in the region are now designated by the federal government as Accountable Care Organizations (ACOs) in Medicare, and patients are expected to see the benefits.

The U.S. Department of Health & Human Services announced Thursday that Wellmont Integrated Network and Qualuable Medical Professionals are among health-care providers across the country that have been selected as ACOs.

As the name implies, Wellmont Integrated Network includes all of Wellmont’s operations, while Qualuable Medical Professionals is a group of physician practices in the region that have banded together. That group includes Holston Medical Group, State of Franklin Healthcare, Mountain Region Family Medicine, Medical Care PLLC, and Highlands Physicians Inc.

Mountain States Health Alliance was selected as an ACO last year.

Dr. Stephen Combs, chief executive medical officer of Wellmont Medical Associates, said an ACO is not managed care like an HMO, in which patients can only see certain doctors and visit certain facilities in the network.

Instead, an ACO directs providers to work together to provide higher-quality care to patients, which in turn provides value in health care, and helps providers better manage patient populations, Combs said.

“If you coordinate the care better it should reduce your re-admissions, it should reduce your overutilization of care, it should really improve patient outcome,” Combs said.

He said the other aspect of an ACO is ensuring that providers not only take care of patients when they’re sick, but to encourage healthy lifestyles to help prevent illness and disease in the first place.

“It really is a different mind-set,” Combs said.

And with the region’s two largest health networks plus several physician groups working together in the ACO process, Combs said he sees opportunity for all of the providers to work together.

“Really we’ll have to, because one ACO may have a specialist and the other one doesn’t. I can have a patient who sees me for primary care in my ACO, and they can go to Mountain States to see a particular specialist there. So the patients will make us work together. It’s the right thing to do,” he said.

As part of an ACO, savings generated from the effort will be shared equally between the ACO health-care provider and Medicare. The government expects the ACO initiative to save up to $940 million over four years.

The ACO designation is part of the Affordable Care Act. Health-care providers designated as ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate and timely.

“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” said Health & Human Services Secretary Kathleen Sebelius.

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