Tucson Medical Center, three community health centers and more than 150 local doctors have invested in a new business they're touting as an answer to the fiscal crisis in U.S. health care.
The goal is to reduce health costs by increasing medical service. While that may sound counterintuitive, it makes sense to those who know that keeping people out of the hospital by giving them more attention with follow-up care will result in long-term savings.
Rather than treating sickness, leaders of Arizona Connected Care - an umbrella entity that will oversee thousands of local patients' care - say their new company will focus on keeping people healthy.
The new business is what's known as an "accountable-care organization," a health-care approach promoted in the Patient Protection and Affordable Care Act of 2010. Many such organizations across the country, including Arizona Connected Care, will begin operations in April.
Patients do not need to do anything to participate. They don't need to leave their insurance providers, nor do they sign up. Patients who get care from providers who are part of Arizona Connected Care will see no changes other than more follow-up and attention from providers in the organization, leaders say.
The providers say such care will turn into cost savings because they'll keep people out of the hospital. Partners in the new organization will split cost savings with the federal Medicare program. For now, only Medicare patients will participate locally.
Each partner in the Southern Arizona group - including El Rio Community Health Center, Mariposa Community Health Center and Marana Healthcare Center - has bought into the partnership for an undisclosed amount. About 15,000 to 20,000 Tucson Medicare beneficiaries from the various partners will be assigned to the new company's efforts in April.
Accountable-care organizations, often called ACOs, aim to bring down health-care costs by shifting their focus from seeing the same chronically ill patients over and over to ensuring patients don't get so sick in the first place.
Now, they say, patients are falling through the cracks. Someone discharged from the hospital after a stroke, for example, might not see his primary-care provider for six weeks after discharge. But 30 percent of stroke patients will have another stroke within five weeks of leaving the hospital - a statistic Arizona Connected Care leaders believe they can turn around by having a "care management nurse" or another organization employee overseeing patients' aftercare, including medication compliance.
Also, when patients get care from different providers like a hospital, nursing home, rehab center and physical therapist, those providers often don't communicate. That's a gap in services that accountable-care organizations like Arizona Connected Care hope to fill.
"If you can keep someone with congestive heart failure at home, managing their congestive heart failure, instead of here, ... it's one of the highest readmissions diagnoses in the United States," said Judy Rich, president and chief executive officer of Tucson Medical Center, whose hospital is driving Arizona Connected Care and has a 25 percent share in the organization. "What that means to us in the hospital is that if we are successful, we will reduce our admissions per Medicare beneficiary."
Kaiser Health News recently called ACO the "hottest three-letter word in health care." Writing in The New York Times, former White House adviser Dr. Ezekiel J. Emanuel and Harvard public policy professor Jeffrey B. Liebman went so far as to say such organizations will one day replace health insurance companies.
But one outspoken critic of ACOs says such talk is delusional. Providers who join together in an ACO don't have the experience to act as health-insurance companies, said Jeff Goldsmith, president of Health Futures Inc. and an associate professor of public health sciences at the University of Virginia. Goldsmith, whose company specializes in forecasting health-care trends, calls the ACO a paternalistic, "we'll decide what you need" kind of model.
"I just think it's a waste of time. It's a diversion of energy, and there's a billion-dollar consulting industry selling tools, fear and horrible things, telling these providers they'll help them be trendy. It's depressing," Goldsmith said. "I want hospitals to do a much better job at being hospitals before they learn a whole new business.
"Instead of learning this whole new thing, I'd choose that hospitals focus on not killing so many of us with avoidable things like medication errors and hospital-acquired infections."
Dr. Rick Johnson first decided to invest in Arizona Connected Care as a physician provider in Saguaro Physicians. About 2,000 to 3,000 Saguaro Physicians Medicare patients will be initially overseen by Arizona Connected Care. Johnson said that had he not held previous medical leadership roles, he would have thought Arizona Connected Care was nothing but another layer of bureaucracy.
"If I felt like someone was adding another layer on there, giving me more busywork to do, this would be a bad idea," said Johnson, now medical director for Arizona Connected Care. "This is an attempt to take disparately owned groups that are actually finding a way to get together, work together to make health care more affordable and better for the patients."
Part of National report
The Tucson organization is one of four case studies that were part of a recent national report on accountable-care organizations by the Commonwealth Fund, a private foundation that has a goal of improved health care.
"We all know the health-care system we have cannot deliver the care it needs to at the costs we're currently running at," Johnson said. "It's a system that's not functional over the long haul. So we're all trying to find a way to lower the cost overall and make it a better experience for the patient. The ACO is the current best-known model of how to do that."
Innovative Practices Administrator Mike Cracovaner, whose company is another partner in Arizona Connected Care, said his group will oversee patient care in the organization, making sure no one falls through the cracks.
His company plans to use data analysis provided by another group participant, Optum, to identify patients who may not be complying with their treatment, call them and ask them to come in for follow-up care.
The Commonwealth report says one of the biggest challenges for Tucson Medical Center remains overcoming negative local experiences with managed care. TMC's Rich said that when explaining it to others, she often has to clear up misconceptions about the new company.
No, this is not an HMO, she emphasizes.
No, it will not mean any denial of care.
No one is mandated to participate.
No, patients will not find themselves in any kind of a network without options.
The only changes patients are likely to notice is that they'll be getting more attention from various health-care providers, she said.
"This, I would say, is one of the least controversial elements of the health-reform law," attorney and Arizona Connected Care administrator John Friend said.
Still, there are kinks to work out. One of the biggest is that the groups have various, different forms of electronic medical-record systems that don't all talk to each other.
"We let entrepreneurship drive making electronic medical records," said Johnson, Arizona Connected Care's medical director. "Every institution and group has a somewhat different system, and they don't interface well."
Changing that will be a key to the organization's success, but Rich remains optimistic:
"This really is the kind of care we all want."
More information online
• Commonwealth Fund report on Tucson's Arizona Connected Care: www.commonwealthfund.org/Publications/Case-Studies/2012/Jan/Tucson-Medical-Center.aspx
• Video about Tucson Medical Center's role in the accountable-care organization: www.tmcaz.com/TMCHealthcare/AccountableCareOrganization
• Information about accountable-care organizations: www.cms.gov/ACO/
Contact Star reporter Stephanie Innes at firstname.lastname@example.org or 574-4134.