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In R.I., an apparent big ACO success

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The Rhode Island flag.

Read how a Rhode Island clinicians group, Coastal Medical, is making an Accountable Care Organization work.

As Felice Freyer, of The Boston Globe, reported: “Coastal Medical, now in its fourth year, stands as an example of an ACO that seems to be making it work: In 2014, it saved $7.2 million while maintaining high ratings for quality.” ACOs, by taking on the financial risk of caring for a population, can be financially rewarded by the Centers for Medicare & Medicaid Services when it saves money.

Some of the things Coastal does, reports Ms. Freyer:

“To prevent needless emergency room visits, Coastal has office hours 365 days a year and stays open till 9 on weeknights.

“To help keep sick and recovering patients at home, nurse care managers work in hospitals and nursing homes to ensure patients have the services they need when they’re discharged.

“When a Coastal patient shows up in the emergency room, the hospital has immediate access to a Coastal doctor who can see the patient’s medical record and help with treatment decisions.”

Ms. Freyer continues:

“{A}ccording to federal data, Coastal (whose patients include residents in nearby Massachusetts) ranked highest in overall quality of care among the 19 ACOs working in Massachusetts and third-highest in the nation. The Medicare program measures quality based on 33 criteria, from percentage getting flu shots and mammograms to how well patients’ diabetes or heart disease is being managed.

“At the same time, Coastal saved money, trimming the cost of care for its Medicare beneficiaries by 7.25 percent in 2014, by reducing the use of hospitals, emergency departments, and nursing homes.”

“The ACO concept aims to encourage providers to take care of all their patients, not just those who come in with complaints, and to keep track of how patients are faring.”

“That means reaching out to patients with serious health conditions — diabetes or congestive heart failure, for example — and urging them to come in for care.

“It also means careful data-gathering and tracking, a task made easier at Coastal by an electronic medical records system in place since 2006.”

“Unlike many ACOs, Coastal isn’t working with Medicare alone. It has similar shared-savings arrangements with the three major health insurers in Rhode Island, and it offers the extra services to all its patients.”


Contact Info

(617) 230-4965

Wellesley, Mass