Issue link: https://nebusinessmedia.uberflip.com/i/482401
20 HEALTH • Spring 2015 Experts say risk-based contracts are about quality, as well as costs \\ By Emily Micucci F or health insurance companies, managing costs has always been a game of risk, one doctors have largely stayed out of — until now. State and federal health care reform has led to important changes in the health care market. In Massachusetts, there's a major emphasis on reducing spending, and on the federal level, the government is trying to curb the high cost of delivering care to senior citi- zens and low-income residents. Plus, the universal mandate that forbids insurers from deny- ing coverage because of pre-existing conditions has made health insurance more expensive for just about everyone. As a result, doctors, hospitals and other providers are starting to take on the risk that insurers used to bear alone, and consumers will begin to see changes in how their care is managed. PROVIDING HEALTH CARE ON A BUDGET? UMass Memorial embarks on 'population health management' The most prominent local example is UMass Memorial Health Care, the largest health care pro- vider in Central Massachusetts. The health care system formed a new entity, called an accountable care organization (ACO), in January. The ACO program is a voluntary one run by the federal Centers for Medicare and Medicaid (CMS). Bearing the name "UMass Memorial Health Care A c c o u n t a b l e C a r e Organization," the ACO will manage the care of a certain number of senior citizens who receive Medicare insurance and see doctors in the UMass Memorial network. The ACO will be assigned patients — a process underway now — and it will be the orga- nization's responsibility to take care of them within a budget. Staying within it means UMass Memorial shares part of the savings; exceeding it means they share in the costs. Quality performance stan- dards issued by Medicare are designed to ensure that care isn't sacrificed in order to save money. Patrick Muldoon, CEO of UMass Memorial Medical Center in Worcester, the system's flagship site, said the approach, known as "population health Case managers like Casey Bogan, left, are becoming more important as insurers and providers ink more risk-based contracts. Bogan, who works for Fallon Health, is shown with her patient, George Poulin. P H O T O S / E D D C O T E Patrick Muldoon, CEO of UMass Memorial Medical Center in Worcester