A somewhat experimental approach to the way doctors and insurers care for patients is expanding in the Delaware Valley. The region’s second largest insurer, Aetna, has reached a deal with the Delaware Valley Accountable Care Organization, the area’s largest accountable care organization.
Accountable care? What does that even mean, you may ask.
Health care is traditionally delivered through “fee for service.” A patient sees a doctor, gets a test, and then the doctor bills for it. More or less.
But in this newer model, called accountable care, doctors work within an umbrella organization that helps coordinate that care. The idea is to help steer patients through what can be a very disjointed health system, and financially reward doctors for keeping patients healthy.
The largest effort in Philadelphia is DVACO.
“We’ve intervened actually within the emergency room with a patient who would have ended up getting admitted,” said CEO Katherine Schneider, pointing to the kind of infrastructure and resources her group can provide. “But we knew they were there in real time and a primary care physician was able to help coordinate with the skilled nursing facility where they had come from and really avoid that admission.”
That, in turn, can prevent higher cost care and complications, she said.
That’s the idea.
Schneider’s group, DVACO, is owned by several area hospitals — Main Line Health, Jefferson Health, Holy Redeemer Health System, Doylestown Health and Magee Rehabilitation Hospital.
DVACO already oversees care for about 100,000 people who have Medicare and has arrangements with 671 primary care doctors. Now Aetna has signed on, marking the group’s first deal with a commercial insurer, adding about 70,000 more patients to the fold who already get care with those participating doctors.
“It’s a really important move for us because of course we’re trying to create some critical mass to change the care model,” said Schneider.
This kind of approach is being tested out across the region and country. The Affordable Care Act has kick-started a lot of it through grants and other policies.
Robert Field, a professor at Drexel’s Dornsife School of Public Health and Thomas R. Kline School of Law, said the downside for some patients is it may limit their options to access care. Overall, he said the approach is really promising, but it’s too soon to know how well it’s actually working.
“Part of the hard part is the most challenging patients are the ones with chronic conditions,” he said. “And those are the conditions that develop over years or decades, so it’s going to take years or decades to see whether these new arrangements help them or not.”
The DVACO expansion takes effect in April.