Essentia enlists in Medicare efficiency effortEssentia Health is turning health care on its head, Medical Director Mike Van Scoy said Monday.
By: Mike Creger, Duluth News Tribune
Essentia Health is turning health care on its head, Medical Director Mike Van Scoy said Monday.
No longer are doctors simply responding to medical emergencies. Teams at Essentia are working to prevent them from happening.
“It’s not a clinic visit and ‘see you later,’” Van Scoy said of what the health company has been doing for a decade to change from a “fee for service” company to one that focuses on preventive medicine.
It’s an intense, all-encompassing information approach to patients with multiple chronic medical issues. In short, Essentia is surrounding these patients with a team that knows their struggles and works to keep their health on track. It’s called coordinated care.
On Monday, the federal government recognized Essentia’s approach to its sickest patients by naming it an Accountable Care Organization to serve Medicare and Medicaid patients.
Essentia runs clinics and hospitals across Minnesota, Wisconsin and North Dakota, including St. Mary’s Medical Center and clinics in Duluth. It will now take part in the Medicare Shared Savings Program that is designed to save taxpayers money by lowering patient costs.
Health-care companies are being rewarded through the 2010 Affordable Care Act to be proactive in their approach with the goal of keeping people healthy before a crisis comes up.
“You’re not just responding,” Essentia Chief Operating Officer John Smylie said. “We’re working on prevention.”
Smylie said the Shared Savings Program is a big change from the days when doctors were “only paid when something breaks.”
Van Scoy said the program will deal with the sickest 10 percent of the population — those with multiple chronic diseases — and especially with the 2 percent within that group who are the most vulnerable.
But even healthy Medicare patients will benefit from the savings program with the promotion of checkups and screenings with primary care doctors.
Medicare has functioned mostly reactively for years, offering doctors reimbursement for care after patients get sick. Under the 2010 act, health-care providers will get similar incentives for closely monitoring the most chronically ill before costly procedures are required.
Smylie said it’s a way to prevent emergency admissions and “get paid for it.”
Jonathan Blum, the director of the Center for Medicare, announced Monday that 89 health-care companies were added to the Accountable Care Organizations list. It named 27 partners in April and now has 154 organizations working with Medicare to shave costs.
Accountable Care Organizations are networks of hospitals and doctors that receive financial incentives to coordinate care for a defined population of patients. The companies had to prove to the federal agency that they could save taxpayer money.
If an organization can manage to keep down costs by avoiding unnecessary tests and procedures, while also demonstrating quality care, the company gets to keep a share of the savings. As models, the administration cited highly touted health systems such as the Mayo Clinic in Minnesota and the Geisinger Health System in Pennsylvania. Essentia is the only company in the region named to the list.
More than 2.4 million Medicare patients are part of the savings initiatives in 40 states.
When the idea of Accountable Care Organizations came up in the health-care act debate, some were skeptical about companies signing up to reduce charges.
“There were many doubts about whether ACOs would come into the program,” Blum said in a telephone conference call. “Obviously we are pleased with the overall numbers.”
New partnerships will be announced each January after the initial groups this year. Blum said more than 400 health systems have lined up to apply.
Registered nurse Cathy Martin has worked the past year with frequent visitors at the emergency room of St. Mary’s Medical Center. She has become the main link in a support team for patients with chronic health conditions to keep them out of critical care.
Martin connects patients with doctors and other resources.
“It’s very patient-centered and patient-focused,” she said. “I have a passion for people who need that extra help.”
Martin works closely with care coordinators like Sherry Doskey at Essentia’s clinic in Superior. Doskey helps patients with conditions like heart disease and diabetes to maintain their health.
“They’re almost like family members,” Doskey said.
Nurses and doctors work as a team to come up with a care plan for patients, Doskey said. Coordinators like herself are available by phone and pager at all times.
Doskey will often sit with a patient to talk about a coming visit with a primary care doctor. She helps them write down pertinent questions to ask and discusses medications.
For now, the coordinated care is focused on Medicare patients. But Doskey sees a day when everyone will have the same intensive preventative care.
“It can really help all patients,” she said.
The Associated Press contributed to this report.