Information for clients/patients needing legal assistance around lost benefits or insurance.
The movement of many insured into “managed” environments has resulted in some questions to the HCA of MA regarding clients’ rights should home care services be terminated or suspended. Every Managed Care Organization (MCO) or Accountable Care Organization (ACO) – be they serving Medicare or Medicaid clients – has an obligation to have some form of patient (although not necessarily agency) internal appeal process. Agencies who are working with these organization should be versed in what these processes are.
For clients for whom the changes are threatening their well being, or seemingly discriminatory, or based on a pattern of inappropriate clinical decision making, there are legal services entities in this state who may be able to help. This list includes their names and contact information. Please note: these legal services entities will generally only take up a case if a client or, in some cases, a family member of a client calls. Keep this information on hand and share with any client who may need assistance.
The Home Care Alliance’s annual Financial Managers Conference was held last week at the Conference Center at Waltham Woods. The conference included presentations on benchmarking and operational efficiencies (from principals from BKD and McBee Associates), as well as a presentation from Emily Brower, the Director of ACO programs at Atrius Health. Atrius Health is one of five Pioneer ACOs in Eastern MA. Ms Brower’s presentation was summarized in Home Health Technology Report by Tim Rowan, who was also at the conference to present on IT Trends.
Ms Brower talked frankly about their need to manage costs, their dependence on their home care agency VNA Care Network/VNA of Boston and their progress in creating truly integrated plans of care. Read Tim Rowan’s summary here.
Last week, CMS announced 106 new ACOs, bringing the total approved by CMS since passage of the Affordable Care Act to 250. The nine newly designated “Shared Savings” ACOs in Massachusetts are:
Accountable Care Organization of New England (led by Mercy Medical Center President & CEO Dan Moen); Cambridge Public Health Commission (Cambridge Health Alliance CEO Patrick Wardell); Cape Cod Health Network ACO (Cape Cod Health’s Sr. VP, Managed Care Jack Lipomi); Lahey Clinical Performance Accountable Care Organization (Lahey Health System Chief Network Development Officer Gregory Bazylewicz, M.D.); Pioneer Valley Accountable Care (CEO of Baycare Health Partners Stephen Sweet, M.D., affiliated with Baystate Health System); Southcoast Accountable Care Organization (Southcoast Hospitals Group President & CEO Keith Hovan); Total Accountable Care Organization DBA Collaborative Health ACO (President of MetroWest Accountable Healthcare Organization Bethany M. Gilboard); Winchester Community ACO (Winchester Hospital Board of Directors member Dale Lodge); and Accountable Care Clinical Services (Chairman and CEO of Accountable Care Associates, Dr. Philip F. Gaziano).
Here is the official list from CMS of all 106 ACOs and their contact information.
In other ACO news, this week’s MHA Monday Report reports that Boston’s Beth Israel Deaconess Medical Center (BIDMC) has redesigned their existing Pioneer ACO. They are entering into a partnership with the 1,600 physician Beth Israel Deaconess Physician Organization to create the newly designed Beth Israel Deaconess Care Organization (BIDCO).
According to a press release from BIDMC, “The hospitals and physicians will work in 50-50 partnership within BIDCO, sharing governance, joint contracting, and risk. It is designed to accommodate community hospitals and physicians that are not owned or employed by BIDMC, and results in a restructuring of the current Beth Israel Deaconess Physician Organization to add hospital ownership for purposes of jointly contracting with payers in the future.” The hospitals and physicians will jointly invest $12 million annually for five years to improve the coordination of patient care among hospitals and physicians, as well as to increase the ability of caregivers to focus on population health management.
The Beth Israel Deaconess Physician Organization had previously been designated by CMS as one of only 32 Pioneer ACOs – a designation recognizing groups that had taken an early lead in coordinating care for patients across care settings. That Pioneer designation transfers to the BIDCO.
Health and Human Services (HHS) Secretary Kathleen Sebelius announced today the approval of 89 new Accountable Care Organizations (ACOs). The 89 new ACOs have entered into agreements effective July 1 with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. Among the 89, there are two in Massachusetts:
Circle Health Alliance, LLC, located in Lowell, Massachusetts, is comprised of partnerships between hospitals and ACO professionals, with 353 physicians. It will serve Medicare beneficiaries in Massachusetts and New Hampshire.
Harbor Medical Associates, PC, located in South Weymouth, Massachusetts, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Massachusetts.
The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives to 154. Of these, there are already five entities in Greater Boston designated as Pioneer ACOs by CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) announced last December. There are an additional two physician practice demonstrations, one south of Boston, the other on Cape Cod.
For 2012, CMS has established for all ACOs 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.