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Northeast Medical Group chosen for Medicare program

New Haven Register (CT) - 1/24/2015

Jan. 24--NEW HAVEN -- The Northeast Medical Group, a medical foundation associated with the Yale New Haven Health System, is the latest in Connecticut chosen to participate in the Medicare Shared Savings Program Accountable Care Organization.

As an ACO, the goal is for practitioners to work across specialities and with hospitals to save money by coordinating care and emphasizing prevention.

The incentive for the participants is that they get to keep some of the savings that Medicare realizes through their efforts.

The state appears to have less than a dozen ACOs in the shared savings program, according to the American Academy of Physical Medicine and Rehabilitation.

The Northeast Medical Group, founded in 2010, represents more than 115 practices and 700 physicians and medical professionals affiliated with Bridgeport, Greenwich and Yale-New Haven hospitals.

Whether it is the largest in the state could not be determined Friday as Northeast was waiting for that information from the Center for Medicare and Medicaid Services.

The size of an ACO, however, is determined by the number of beneficiaries, as opposed to the number of doctors.

The Northeast Medical Group was one of 89 groups selected by CMS this week, bringing the total across the country to 405 serving some 7.2 million patients.

CMS said in a statement that ACOs that started in 2012 improved on 30 of 33 quality measures, including ratings on communication, patients' judgments of doctors and screening for high blood pressure.

The combined cost savings across the country was $417 million for the shared savings program and for the separate Pioneer model.

CMS reported that spending per beneficiary was essentially flat in fiscal 2014; from 2010 to 2014 it grew at a rate of 2 percentage points per year less than growth in gross domestic product per capita.

ProHealth, a large group of mainly primary care practitioners enrolled in an ACO, in a report to Comptroller Kevin Lembo in December, reported that it reduced their patients' visits to emergency rooms and hospital admissions.

They still failed, however, to achieve a bottom line savings because of increasing hospital costs, over which they had no control.

"This model isn't really working the way it hopefully would be," John Lynch, vice president for research and government affairs for the organization, said of their first year in the plan.

Ellen Andrews of the Connecticut Health Policy Project said in testimony before Lembo, that of the 11 Medicare ACOs in Connecticut, only one was successful in earning a shared savings bonus.

"ACOs are relatively new, especially in Connecticut, and there is little evidence for effectiveness at improving value even in more mature, better sophisticated systems from other states," she wrote in testimony before Lembo's committee.

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