Exec provides details on Duke’s new ACO

Dec. 30, 2013 @ 05:41 PM

Duke’s new Accountable Care Organization will begin operations on Wednesday, involving 1,700 doctors from Duke, the Lincoln Community Health Center and three other practices.

As part of the organization, physicians will try to coordinate care for Medicare patients to reduce unnecessary health costs. Created as part of the Patient Protection and Affordable Care Act, ACOs allow providers to share in any cost savings they achieve when they also meet certain quality standards.

Duke Connected Care, which is the name of Duke’s ACO, was one of 123 newly approved ACOs announced last week by U.S. Department of Health and Human Services Secretary Kathleen Sebelius. More than 360 ACOs have been created since the federal health overhaul passed, according to the announcement.

Dr. Devdutta G. Sangvai, executive director of Duke Connected Care, associate chief medical officer for the Duke University Health System and a family physician, said Duke officials looked at existing ACOs in North Carolina before launching their own. They decided to get involved, he said, because they see it as an opportunity to improve care for Medicare patients.

He said ACOs also represent the “shifting tides” in health care. The move is toward a greater focus on population health, he said, which involves looking at health care outcomes for groups of people. He added that Duke has also had experience in providing managed care to specific patient populations, such as to Medicaid patients and to Duke employees.

In talking to health care officials involved in other ACOs in the state, he said, they saw it was useful to manage patient health care in and outside of the doctor’s office, nursing home or hospital. For example, he said there may be opportunities to coordinate patient care when patients move between the care of primary and specialty physicians, or after they’re discharged in tracking whether patients have filled their medications or are taking them.

“That care management allows you to improve quality of care, decrease utilization, and as a result, decrease (cost),” he said.

He said Duke will add additional care managers and will be using their electronic medical record system as part of the coordination effort.

He said the program is structured so that the Centers for Medicare & Medicaid Services creates an anticipated cost for a group of Medicare patients. Doctors continue to be paid in the fee-for-service model, but he said they’re able to share in any savings compared to that anticipated total amount for the group.

“If you can do that at a lower cost, then those savings (are) available to the ACO for having provided that at a lower cost,” he said. “The key here is, that model only works if your quality is maintained.”