Studies show that minorities are much less likely to see a doctor than whites, let alone taking the time or having the ability to see these physicians on a regular basis.

But that could be on the verge of changing with the new model of health care delivery, known as Accountable Care Organizations (ACOs), gaining momentum in Medicare. These ACOs group together medical care providers in hopes of improving quality of care and outcomes while at the same time saving money. If the doctors, hospitals and other providers that are a part of an ACO achieve better health outcomes less expensively, Medicare shares the money saved with the ACO.   

Across the country, there are opportunities for story after story of patients, medical care providers or health plans working with Medicare, employers and private insurers to implement ACOs. It’s the program that could hold the most promise as policymakers and politicians look to preserve Medicare by reducing funding, particularly to hospitals, for unnecessary payments for expensive inpatient medical care.

The idea behind ACOs is that medical care providers are incentivized to give Medicare beneficiaries better care upfront, before they become sick and treating them becomes more expensive. That means minority populations such as Latinos and African Americans must be drawn into the ACO system early if it is to work effectively.

“The shift is toward population management,” said Michael Englehart in an interview with MNG. Englehart is president of Advocate Physician Partners, a doctor group that is affiliated with hospital operator Advocate Health Care, the largest medical care provider in the Chicago area. “Rather than wait for this patient, let’s make an outbound phone call.”

ACOs are taking on particular importance in Medicare with policymakers, Congress and the White House unable—or unwilling—to spend more on medical care. It begins when Medicare contracts with an ACO, which then groups certain providers into one entity in order to offer high-quality, coordinated medical care that tends to be outpatient-based and less expensive than the program’s traditional payment system. That system is fee-for-service, and it can lead to excessive and unnecessary care because it pays for each individual treatment and procedure, many of which may not be needed or are duplicative. The providers in an ACO are responsible for managing the care of the health plan patients and are financially rewarded if they are able to keep enrollees healthier while avoiding expensive inpatient care and services.

For the African American and Latino populations, ACOs use patient advocates and nurses, known as care managers, to reach out to these minority groups and ensure they are getting the necessary medical care. Social workers can also be used for patient outreach.

Based on studies, minority populations could both benefit the most healthwise and save Medicare the most money if they receive the outpatient medical care that they need. A 2006 study by The Commonwealth Fund showed the percentage of adults reporting “no regular doctor” was significantly higher among blacks and Hispanics than among whites.

Among whites, 21 percent of adults reported having no regular doctor while 28 percent of blacks reported the same. In the Hispanic population, it was much worse, with nearly 2.5 times as many Hispanics, or 51 percent, reporting having no regular doctor.

When patients lack a regular medical professional, they often have inadequate health information on how to access and use the health care system, or none at all, The Commonwealth Fund study indicated.

Supporters of ACOs say increasing regular contact with medical care providers is key to improving medical quality.

“We want to make sure the outpatient care managers can speak Spanish and are from the community,” Englehart says. “We’re trying to use our outpatient care managers and coaches and say, ‘Who is out there?’, ‘Who is a ticking time bomb?’ We need to pull in these patients.”

Advocate and other ACOs across the country reach out to patients through care or case managers. The care manager is a quarterback of sorts, leading coordination of care with a physician and a team of caregivers. Patients with chronic conditions in some of the nation’s early ACOs say they are getting more attention from medical care providers.

Take Rochelle Rudder of Chicago’s South Side who has five doctors, including an allergist and a psychiatrist, for treatment of multiple health issues that include C.O.P.D., asthma and severe arthritis. Rudder, who is African American, is on disability from a management job she had in AT&T’s real estate division and admits she has had trouble juggling her medicines and doctors without help from a care manager.

Rudder, who is 54 years old, told The Medicare NewsGroup (MNG) that her care manager at Advocate Health Care has been helpful in organizing her appointments and ensuring that she sticks to her regimen of medications. The care manager has also been able to cut through bureaucratic red tape.

“I fell back in November, hurting my ankle, and needed what they call an air brace,” Rudder said. “When I ordered it from the medical equipment company, they couldn’t seem to find my order.”

Rudder, who also suffers from depression and anxiety, said she couldn’t deal with tracking down the lost brace on her own and might have just gone without it. “I still think of myself as being anti-social but am less so and much calmer when I have someone to help me with my problems,” Rudder said.

Her care manager said the goal of trouble-shooting problems like the one Rudder described is to reduce more costly care that might result if there were no intervention.

Advocate has operated an ACO that has a contract with Blue Cross and Blue Shield of Illinois for more than a year. In July, Advocate started a contract with Medicare and has begun outreach through care managers to more than 110,000 Medicare beneficiaries.

Advocate, which already has 90 case managers in its contract with Illinois Blue Cross, added another 60 to 70 case managers over the summer to work with the Medicare population. The care managers are a mix of nurses, social workers and other patient advocates.

In the minority populations, Advocate says it makes sure that it has plenty of interpreters and related technology to ensure that health care providers have 24-hour access to translation services so they can communicate with myriad patients with different languages, given Chicago’s diverse patient population.

“We have always been proactive about our interpretation skills,” Englehart says. “We have invested both at our hospital and at our (outpatient) sites. We can do video and teleconferencing around the clock.”

In Medicare alone, more than 150 doctor groups, hospitals and health systems like Advocate have signed on to participate in the federal government’s ACO program, known as the Medicare Shared Savings Program, an initiative under the Affordable Care Act signed into law two years ago by President Obama. More than 2.4 million Medicare beneficiaries—surpassing an original goal for this year of 2 million—will receive care from these ACOs, the Centers for Medicare & Medicaid Services announced in June.

Given that ACOs will be rewarded if they give their Medicare populations better care upfront, minority Medicare patients will be difficult to ignore if the providers are to reap shared financial savings.

If health care systems have Latino, African American or other minority populations that have not seen a doctor in the last two years, Englehart has some advice: “You need to be thinking about what other patients are sitting out there before they show up in the emergency room.”

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Related Links

MNG Medicare FAQs

What Are Accountable Care Organizations (ACOs)? 

How Will the Creation of Accountable Care Organizations (ACOs) Contain Rising Health Care Costs? 

How Will the Creation of Accountable Care Organizations (ACOs) Impact Private Insurers? 

How Will the Creation of Accountable Care Organizations (ACOs) Impact Medicare Beneficiaries?