Heathcare Reform

WHAT IT MEANS TO YOU

Since January 2012, Medicare began rewarding networks of doctors and hospitals for what are called population management results — the results of providing good quality care to large groups of Medicare patients, while keeping costs down. This new healthcare model, which is known as the Accountable Care Organization (ACO) model, differs from the old fee-for-service model where physicians were rewarded for their volume of patient visits.

How your healthcare providers will be paid

Under healthcare reform, the government will begin bundling payments to Medicare providers to cover acute-care inpatient services, including readmissions; outpatient hospital services, including visits to the Emergency Department; and physician care, including services in and out of the hospital. Also included will be post-acute-care services, such as home health, rehabilitation and nursing home care. By law, these bundled payments will not be higher than what would otherwise be paid for the same services under current Medicare provisions. It’s likely that other private health insurance companies will follow the government’s lead in reimbursing providers collectively through ACOs, rather than individually.

ACO standards and benchmarks

To qualify as an ACO, certain quality performance standards and benchmarks must be met. Because an ACO must agree to manage all the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years, ACOs have the opportunity to impact and improve healthcare for thousands of people through chronic disease management. Here in Suffolk County for instance, we have over 1.4 million people whose lives can be positively impacted by the ACO of which Stony Brook Community Medical is a participating member.

Preparing for the future

Stony Brook Community Medical is already prepared for healthcare reform with new tools and procedures in place to monitor and analyze data and make adjustments that will help minimize situations where a patient has to be hospitalized or seen in an emergency setting. In the event a situation should arise that requires a patient to be hospitalized, we’ve also ensured that our physicians and their patients have access to the world-class experts and resources at Stony Brook Medicine.

Communicating better to ensure the right care at the right time

As with all relationships in life, communication is key. In healthcare, it’s vital. Because our network of doctors, hospitals and other medical professionals across the continuum of care share responsibility for providing the right care at the right time, you can expect to see improved communication regarding the coordination of care for yourself and those in your care.

Read more on how we’re enhancing the coordination of patient care.