New York ACO achieves quality improvement, big financial gains

After launching an accountable care organization program a year and a half ago, WESTMED Medical Group has improved quality metrics, increased patient satisfaction and just recently received a big bonus check for its results.

The Purchase, N.Y.-based group practice received nearly a $1 million bonus under its ACO agreement with United Healthcare. The organization proved reductions in practice variation, decreased duplications in care and promoted the proper setting for care.

[See also: Pioneer ACOs show savings.]

The 260-physician group practice launched its ACO in collaboration with UnitedHealthcare and Optum in mid-2012, with more than 13,000 individuals participating.

Already, the ACO is performing above the 90th percentile of National Committee for Quality Assurance Quality Compass for providing the highest level of coordinated care for breast cancer and cervical cancer screenings, according to WESTMED officials.

"Our initial results exceeded our expectations," said Barney Newman, MD, WESTMED's medical director, in a Tuesday news release announcing the results. "We'll continue to look for ways to collaborate and share accountability for patient care to surpass these already strong results."

Officials say they’ll expand the ACO program in 2014 to measure a greater number of metrics, and increase the number of plan participants in this program, including Westchester-based UnitedHealthcare fully insured plan participants, while continuing the ACO with the initial group.

"Our initial results with WESTMED are a clear indication of the positive results that can be achieved when medical professionals and insurers come together for a common goal -- getting patients to the right care at the right time in the right setting for the best outcomes," said Sam Ho, MD, chief medical officer of UnitedHealthcare, in a statement. "We look forward to the next phase in our ACO collaboration as we strive to help patients achieve better health."

Back in July, UnitedHealthcare announced it would double the number of ACO contracts over the next year, representing more than $50 billion of reimbursements by 2017. Today, more than $25 billion of UnitedHealthcare's annual physician and hospital reimbursements is tied to ACOs, centers of excellence and performance-based programs.

[See also: ACOs have potential for big savings, reduced readmissions .]

Not all ACOs are seeing such success, however. CMS' Pioneer ACO program, which initially boasted 32 members, has seen nine jump ship from the program, with two groups washing their hands of CMS ACOs altogether.

Plus ACO, which includes Texas Health Resources and North Texas Specialty Physician, is one group that announced back in July it was leaving the Pioneer model and was skipping out on other shared savings ACO as well. Texas Health spokesperson Wendell Watson told Healthcare IT News back in July one of the biggest challenges they experienced was targets not being set at the beginning of the year.

"Pioneer model’s benchmarks can move throughout the plan year," he wrote in an emailed statement. And that's like trying to get a bullseye on a moving target. Because of how the benchmarks were set, Plus ACO is at risk of paying $6 million to $9 million in annual penalties.

The other eight saying sayonara to the Pioneer program include: Prime Care Medical Network; University of Michigan; Physician Health Partners; Healthcare Partners Nevada ACO; Healthcare Partners; California ACO; JSA Care Partners; and Presbyterian Healthcare Services.