The Anthem accountable care organization would mirror MaineHealth's Medicare model, folding in Anthem customers and the same group of more than 1,000 physicians, largely primary care doctors, said Andrea Patstone, vice president of strategic initiatives for MaineHealth.
fails to meet savings and quality goals, it would owe some money back, Patstone
While it's a new approach, MaineHealth
's accountable care organization with Anthem is still rooted in the existing "fee for service" model in health care in which hospitals and doctors are paid for each procedure and visit.
But the endeavor will be key to transitioning MaineHealth
to a new health care landscape in which payments will be based less on volume and more on patients' overall health, Patstone
The arrangement will lead to more personal care and allow providers to better spot gaps in patients' treatment, she
"Patients, given their age or their health conditions, need different things," she
"Somebody who is in their mid-20s needs a different kind of care than somebody who is in their late 60s.
What these arrangements allow us to do is combine information, with patients' permission, from the insurance side and the health system side to do a much better job at identifying and segmenting our patients according to what they need."
For example, a doctor could more easily spot when a diabetic patient is overdue on routine testing and reach out to ensure the patient gets it, she
A primary care doctor will know more readily if a patient was recently discharged from the hospital, leading to better follow-up care that could prevent a costly and avoidable readmission, Patstone