July 12--Talk of medical providers shunning the growing number of Medicare patients doesn't ring true in the New Bern area where the retirement-age population is the fastest growing group.
One local healthcare practice, Coastal Carolina Health Care, is now coordinating care for some of the most medically challenged Medicare recipients, such as those with chronic conditions including diabetes, heart disease and chronic obstructive pulmonary disease.
"We were one of 27 in the country approved for a new Accountable Care Organization (ACO) empowered by the Affordable Healthcare Act," said Steve Nuckolls, Coastal Carolina Healthcare CEO. The contract is for three years and nine months.
An ACO is a group of doctors, hospitals and other health care providers who voluntarily coordinate high quality care for Medicare patients, especially the chronically ill, to make sure they get the right care at the right time. The coordinated care aims to eliminate unnecessary duplication, prevent errors and deliver the best care while using healthcare dollars wisely.
"We're excited about the program," Nuckolls said. "Medicare is over half our business. We turn very few patients away. Our community is blessed in that regard. There are enough physicians to go around and, in our business model, we are able to offer those services."
The Medicare Shared Savings Program will be supervised by a person known widely in this area for offering compassionate health care, former MERCI Clinic Director Nancy Alexander.
MERCI Clinic is a non-profit community clinic operated since 1996 with mostly volunteer physicians to provide free healthcare services for medically uninsured adults in Craven, Pamlico and Jones counties.
Alexander began July 2 as coordinator of what will be team of 10 other registered nurses -- there are now four others -- who look at cases of up to 700 of Coastal's 11,300 Medicare beneficiaries for ways to make their healthcare better.
Dr. Ronald Preston, the Coastal physician designated to oversee the program, said "The goal of Nancy's department is to come up with strategies" to keep Medicare patients with chronic illnesses in their homes so they don't have to go to the emergency room or hospital.
"The idea is increasing access to care for the sickest of the sick and everybody in Medicare by getting to a person early, like making sure bronchitis doesn't turn into pneumonia, so they don't have to be put on a ventilator," he said.
That offers dual benefit for the patient and the country.
Patients identified, contacted to participate and accepting of the offer to be part of this program will have access to 24-7 triage care through a Chapel Hill team including UNC Medical Center, Preston said, and "A new program for us to serve our patients who would benefit from this."
They would have access to the patient's medical records so their immediate concern can be analyzed, possibly eliminating a visit and long wait at the emergency room.
Alexander said her group will initially go to their homes, if they want, and look for ways to make their lives safer and their care easier. They will work with patients and hospital discharge staff, home health staff hospice agencies, meals-on-wheels and various community centers and organizations for the aging.
"We are not replacing anybody," she said. "We're making sure everybody talks to each other. We want to make sure the patient and their families are empowered."
Although Preston is on MERCI Clinic Board of Directors and an active volunteer, he said "We didn't go after her. I mentioned to Nancy we needed a supervisor of care management. We're tickled as pie to have her."
Alexander said "The mission of MERCI will continue. It was time for me to change. A lot of circumstances came into play."
She said Sue Schrenk, former MERCI Clinic board president, is interim manager to help with the transition there.
"It is very important to keep MERCI Clinic out there," she said. "We don't know what North Carolina is going to do with Medicaid expansion and there are 10,000 in Craven County who don't have insurance."
Nuckolls said Coastal will continue "doing everything we can with what we have for MERCI Clinic. Dr. Warren Murray serves as medical director ... We give more than a quarter of a million dollars in services annually and have no plans to change that."
In a for-profit medical practice the ACO hopes to make money for the provider and mostly taxpayer-funded Medicare by sharing in the savings realized by well-coordinated care.
"There are 33 quality metrics that we are graded on," Nuckolls said. "If we don't achieve them, hold the line on cost while achieving patient satisfaction plus measures based on the population we have, we won't receive any shared savings."
"Don't confuse this with the HMO," Preston said. "It has been said than an ACO is an HMO in drag and that's just not the case. They are fee-for-service Medicare patients who retain all the rights they had. They can go and do whatever they could before. We don't want to build fences. We want to make a good pasture so everybody wants to stay."
Nuckolls said, "And, yes. We are taking new Medicare patients."
Sue Book can be reached at 252-635-5665 or firstname.lastname@example.org. Follow her on Twitter@SueJBook.
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