State’s first ‘accountable care organization’ for Medicaid patients to open in Buffalo
Since the passage of the Affordable Care Act, doctors, hospitals and other health care providers have formed groups known as accountable care organizations to better coordinate the care provided to their
Now, state regulators have agreed to let a
The founders of the
"We're radical -- we're probably going to be the Uber for health care," Dr.
The 320 or so primary care physicians and specialists in the local organization handle about 65,000 patients. Major practice groups that have agreed to join include Western New York MRI, MASH Urgent Care, WNY Medical,
The first commercial insurer to join the local organization is YourCare Health Plan, the regional, not-for-profit health plan that serves Western New Yorkers who are eligible for government-sponsored coverage.
Organizers expect the local organization, which is part of the
"We are very excited and ready to begin this journey," said
Accountable care organizations are an innovation of federal health care reform.
The idea, according to the
It's part of the shift from the traditional fee-for-service model, where physicians or hospitals are paid for each procedure or test they perform, to models of bundled payments or those where payments are tied to quality measures and outcomes.
The organizations are created to lower the cost of care, too. Most of the organizations serve
Patients don't join the organization on their own, but they come along with their doctors, Hernandez said. The organization will provide resources to its member doctors to better serve and manage the needs of those patients, the founders said.
The providers must meet quality standards that focus on illness prevention and management of chronic diseases. They receive incentives for keeping their patients healthy while avoiding emergency room visits and inpatient hospital stays, officials said.
For the organization to work, the participating providers must talk with each other. Sharing patient information through a unified system of electronic health records is key, said Dr. Joseph Serghany, a radiologist and president of Western New York MRI, one of the participating provider groups.
Serghany also praised Vazquez's business sense. The local organization is a product of the
The network is consolidating its administrative and health care workers in a
The company, one of the region's largest minority-owned businesses, has 160 employees and will grow to 260 employees when the facility opens next year.
"This group, this business, is doing huge things in the
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