PORTLAND, Maine, July 24, 2013 — Maine Health, through MMC Physician- Hospital Organization (MMCPHO) and Harvard Pilgrim Health Care have announced preliminary results of a 15-month-old Accountable Care Organization (ACO) collaboration to lower costs and guarantee quality of health care services for Maine patients. The MMC Physician-Hospital Organization (MMC PHO) is a nonprofit organization comprised of members of the Community Physicians of Maine (CPM) and representatives from each of the MaineHealth member hospitals, and MaineHealth itself. The MMC PHO serves as the delivery network for MaineHealth Accountable Care Organization. (MHACO.)
MMCPHO and Harvard Pilgrim entered into an ACO agreement effective January 2012. Health care providers such as physician groups or hospitals have traditionally been compensated by the number of services or procedures they perform. But in an Accountable Care Organization, providers focus on patient-centered coordination of care. If they meet quality and cost goals for a specific population of patients, they share the savings with the insurer. A successful ACO requires good communications with patients and coordination of services among hospitals, doctors, and insurance carriers.
During the first twelve months of the agreement, costs were reduced by more than seven percent over the previous year. There was also a 14 percent decrease in inpatient hospital admissions and a seven percent decrease in Emergency Department visits. Additionally, MMCPHO maintained its quality level as measured through Harvard Pilgrim’s Quality Advance Program.
MMCPHO prepared the infrastructure to support an ACO through significant investments in data platforms and care teams and with the help of Harvard Pilgrim quality grants over the last five years. MMCPHO used the grants to expand implementation of Patient Centered Medical Homes throughout the large region that it serves. This is a “model of care” that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety.
“We would like to congratulate MMCPHO on the first year ACO results,” said Ed Kane, Harvard Pilgrim’s vice president for Maine. Our collaboration has been a very positive example of the quality and cost improvements achieved for Maine patients when we work together,” he said. “ACOs have evolutionary significance for improving patient care – and we look forward to supporting them in other regions of our state.”
“Delivering value to our patients and communities means higher quality at an acceptable cost,” said Jeffrey Aalberg, MD, chief medical officer of the MMC Physician-Hospital Organization. “An organization such as ours must develop strong relationships with innovative, agile and like-minded partners, and Harvard Pilgrim is one such partner. We are working together to develop the ACO product, and Harvard Pilgrim has been an important resource and collaborator throughout this process. Building this product together allows us to be flexible and adaptable as we continue to deliver valuable health care in an ever-changing environment,” he said.
About MMC Physician-Hospital Organization
The MMC Physician-Hospital Organization (MMC PHO) is a nonprofit organization incorporated in 1994. More than 1,000 physicians in the Community Physicians of Maine (CPM) partner with MaineHealth, Maine Medical Center, Southern Maine Medical Center, Goodall Hospital, Western Maine Health, Waldo County Healthcare, Pen Bay Healthcare, and LincolnHealth.
The MMC PHO staff works with practices across the state on administrative and clinical projects, such as contracting, quality measures, care management, and implementation of best practices, with the goal of supporting the delivery of high quality, cost effective healthcare to our communities.
About Harvard Pilgrim Health Care
Harvard Pilgrim Health Care is a not-for-profit health plan serving more than one million members in New England. Founded in 1969, the health plan has built its reputation on pragmatic innovation with a goal of lowering costs, improving care and enhancing the overall member experience. Harvard Pilgrim is known for its excellent clinical programs, customer service, health improvement strategies and innovative tools that offer consumers greater transparency and empower them to make better decisions about their health care.
Harvard Pilgrim is the #1 private health plan in America again according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA). Harvard Pilgrim is the only private health plan in the nation to be named #1 for member satisfaction and quality of care for nine consecutive years.*
* NCQA’s Private Health Insurance Plan Rankings, 2011-13, HMO/POS. NCQA’s Health Insurance Plan Rankings 2010-11 – Private. U.S. News/NCQA America’s Best Health Insurance Plans 2005-2009 (annual). America’s Best Health Insurance Plans is a trademark of U.S.News & World Report. NCQA The State of Health Care Quality 2004. Harvard Pilgrim Health Care of New England, Harvard Pilgrim’s New Hampshire affiliate, is the top-ranked plan in New Hampshire and the seventh highest-ranked private health plan in America.