Thursday, July 12, 2012

Moving Forward Down The Path To Lowering Healthcare Costs

It’s a great time for us at the GBMC HealthCare system!

This week, the Centers for Medicare & Medicaid Services (CMS) announced that Greater Baltimore Health Alliance Physicians, LLC (GBHA) was one of the Accountable Care Organizations selected to participate in the Medicare Shared Savings Program, a part of the Affordable Care Act designed to incentivize physicians to improve the quality of care and drive waste out of the system through better coordination. This is part of the Act that is an attempt to lower the cost of care to Medicare beneficiaries.

A subsidiary of GBMC HealthCare (the parent of Greater Baltimore Medical Center), GBHA is the company we started that welcomes both employed physicians as well as private practicing physicians to work towards better health and better care with measurably lower costs. It’s a network (so far) of more than 300 providers.

More than 100 organizations nationwide have been approved for the Shared Savings Program, but GBHA is the first ACO selected in the Central Maryland region and the first in the state with a hospital partner, GBMC. At the outset, more than 10,000 patients will benefit from this new level of collaboration in GBHA.

GBHA was created as part of GBMC HealthCare’s strategic plan that follows from our vision ("To every patient, every time, we will provide the care that we would want for our own loved ones”) of a more patient-centric system where a patient’s needs are better met. This new law aligns the payment system with our strategy. This is a way for us to earn money for not doing unnecessary care. Hospitals have been financially incentivized to deliver medical services and there has been little or no payment to truly manage a patient’s health. Now, if we successfully keep Medicare patients out of the hospital we will be reimbursed for our efforts.

It’s exciting because this is a validation that our strategy is correct to build a strong primary care base in our system. Some doubters have been concerned that the patient-centered medical home would not be successful because no one would pay for it. Now we have more evidence that this is not true. We now need to continue to make our primary care network strong and link it tightly with our wonderful specialists.

With our participation in the single-sided model of the Shared Savings Program, there is no downside financial risk for the entire three-year agreement period. If we don’t end up saving any money, there is no penalty, and hence no risk. If we do save money, GBMC and our doctors will share a percentage of the savings. This is our first formal contract where we are being incentivized for providing patients with Better Health, Better Care, and Lower Cost.

1 comment:

  1. How will we be able to measure that we were successfully able to keep Medicare patients out of the hospital? How will keeping them out of the hospital benefit the patient? Suppose they NEED to be in the hospital and because of the incentivization (and you know this will occur due to a few unscrupulous people) they are not admitted?


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