Thousands of Southern Arizonans enrolled in UnitedHealthcare will soon be able to get care through a unique local business that's intended to contain spiraling medical costs by giving patients more attention.
While that may sound counterintuitive, the result will ideally be fewer chronically ill patients and fewer hospital readmissions, leaders say.
The business, called Arizona Connected Care, is what's known as an "accountable care organization," which is a health-care approach promoted in the Patient Protection and Affordable Care Act of 2010. It's the only accountable care organization in Southern Arizona.
Arizona Connected Care, which started last year with about 20,000 Medicare patients, is expanding to include non-Medicare patients March 1.
Officials with UnitedHealthcare confirmed Tuesday that they are partnering with the business. They estimate 180,000 patients in UnitedHealthcare's employer-sponsored health benefit plans will be able to access the prevention-focused program through local providers.
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Southern Arizona is one of the first markets where UnitedHealthcare is partnering with an accountable care organization.
"It's very innovative. It's eliminating redundant care because there's better contact between specialists, hospitals and other providers. Hopefully we'll see an improvement in the quality of care and access," said Jeri Jones, chief executive officer of UnitedHealthcare's employer and individual markets in Arizona.
"We've been working for a long time with Arizona Connected Care. We're excited to get this thing kicked off and to make some changes in Tucson."
Jones stressed the business is not an HMO, which was a model that focused on managing a population of patients. The accountable care organization aims to focus on managing individual patients, she said. Rather than being rewarded for treating sick people, primary care providers in the accountable care organization will get bonuses for meeting quality standards of preventive care, for example.
Patients will participate as long as their physicians are part of the organization.
Federal data show more than 200 accountable care organizations are in operation nationwide. Many such organizations across the country, including Arizona Connected Care, began last year.
The local business focuses on preventing people from developing the chronic illnesses that are currently stressing the health-care system.
The business includes Tucson Medical Center, three community health centers and about 200 local doctors.
"I think our addition of UnitedHealthcare is very, very important. One of the things ACOs (accountable care organizations) need to do as we invest in these care resources is we need to achieve a critical mass. We need to be big enough to effectively afford some of the new care resources we're bringing to market," said John Friend, executive director of Arizona Connected Care. "If we are really good at our job and we can help you stay healthy and out of the hospital, that is really our goal. We want to keep people home and dealing with their primary care physician."
At least three accountable care organizations are operating in Arizona. Patients do not need to do anything to participate. 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 it will keep people out of the hospital. Partners bought into the organization and split cost savings.
Patients will get attention from "care coordinators" who are employees of Arizona Connected Care. Those coordinators are often registered nurses and licensed social workers who, depending on the case, will go to doctor's appointments with patients, and help patients manage conditions like fluid retention and shortness of breath at home rather than going to the emergency room. They do transitional care to manage patients in the 30 days after they are discharged from the hospital, too.
"It starts with a visit to the patient at the bedside and follows them home," said Karen Popp, a registered nurse who works for the local organization. "We will sit down and talk about goals and help identify community resources and navigate follow-ups. Some patients are very high-risk and need more support than 30 days."
Popp has been working for Arizona Connected Care since it started and says some patients have been shocked by the attention they get after being discharged from the hospital. Often they don't realize how much help they will need.
"It is hard to navigate health care even as a nurse, and I know the system," Popp said. "I take a lot of pleasure in helping patients find their way. It is empowering for them."
Monitoring patients after they are discharged can help keep them from falling through the cracks and improve communication between various providers like a hospital, nursing home, physical therapist and rehab center, officials say.
A patient who is being treated for heart disease will have one record that connects all tests, screenings and medications to ensure the right care is happening.
"We believe this program will clearly demonstrate that proactive care focused on wellness and chronic disease management actually reduces health-care costs," Jones said.
Contact medical reporter Stephanie Innes at sinnes@azstarnet.com or 573-4134.
