ACOs, SCOs, CMS– what do they all mean to you? There has never been a more critical time for America to address senior care than now, as more and more baby boomers turn 65. However, the shifting health care landscape can be confusing. We’re here to help.
What is an ACO (Accountable Care Organization)?
One of the most challenging aspects of our health care system is the problem of fragmentation of care, which impacts seniors disproportionately. As older patients are transferred from acute-care, to post-acute care, to home care settings, the effective coordination necessary to optimize care and recovery can often break down.
According to the Centers for Medicare and Medicaid Services (CMS), “ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors.” The hope is that ACOs will cut costs to the Medicare system while improving quality of care.
In January 2012, CMS chose 32 health care organizations to pioneer the ACO model – five of them in Massachusetts. The Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings.
While not a Pioneer ACO Model per se, Hebrew Rehabilitation Center (HRC) is already taking steps to develop relationships with acute-care hospitals in the Greater Boston area in the spirit of an ACO. As an example, Beth Israel Deaconess Medical Center recently designated HRC as a preferred provider of post-acute services for BIDMC patients, which will promote the seamless transfer of patient care between our two facilities.
Another example of cost-effective care that improves outcomes is a pilot project led by Massachusetts General Hospital (MGH). MGH demonstrated that it could identify patients with high rates of hospital recidivism and, with aggressive personalized case management, reduce rates of readmission. One strategy MGH identified was to admit patients directly to rehabilitative care. When MGH was granted a project extension, they chose HRC as one of their preferred providers.
What is a SCO (Senior Care Option)?
The concern that Medicare and Medicaid payments will not keep up with the cost of care has launched a wave of innovation in payment models for health care plans and providers. These new models move away from the fee-for-service model and are moving toward shared savings and risk. This change will hopefully shift the focus of care toward disease prevention and management.
One model in Massachusetts is the Senior Care Option (SCO) model, a partnership between MassHealth and Medicare that provides a complete package of health care and social services for low-income seniors who are dual eligibles – patients eligible for both Medicare and Medicaid.
Hebrew SeniorLife is known for providing a continuum of care grounded in a similar philosophy. Our community-based health care and wellness programs help keep seniors healthy so they can live independently as long as possible.