By: Beth Blevins

The goal of Accountable Care Organizations (ACOs) is to reduce costs while improving patient care. The Michigan Center for Rural Health (MCRH) is helping two ACOs in their state do just that.

“This is all about changing from volume to value in primary care outpatient settings for Medicare fee-for-service beneficiaries,” said John Barnas, executive director of MCRH. “It’s a care coordination primary care model where primary care providers work together to reduce costs and improve the health outcome.”

After CMS released the guidance for (AIM) grants in November 2014, which provided $114 million in federal grants to help rural facilities make the transition to ACOs, MCRH went to work to promote the idea in their state. “Between November until the deadline at the end of May 2015, we did a lot of outreach,” Barnas said. “We emailed and called a lot of people and held meetings.” As a result of their advocacy, two rural ACOs were formed in January 2016, the and the .

Barnas is listed as the Executive Director of both ACOs. On a day-to-day basis, that means MCRH assists the ACOs in project management and is a meeting convener for them. “We coordinate all the board meetings and minutes and run ad hoc meetings,” Barnas said. “And we set up listservs for every group involved.” In addition, the ACOs can tap into all of MCRH’s resources. For example, he said, if there is a recruitment issue, they can get help from Rachel Ruddock, MCRH’s physician recruiter or, if they need distance education, they can get help from Victoria Lantzy, who runs MCRH’s webinars.

One reason for the success of their partnership with the rural ACOs, Barnas said, is that MCRH is one of only three non-profit State Offices of Rural Health. This gives them “the latitude and freedom to partner on other projects.”

Caravan Health provides backroom analytics for the ACOs by merging a patient’s electronic health record with Medicare claims-based data, a necessary requirement of being an ACO. Through those analytics, Barnas said, “They can see exactly how many times a patient in one of the ACOs has seen the physician, where they’ve seen the physician, the diagnoses, the cost, and number of co-morbidities they have. In this way, they can start identifying high-cost patients whose care they want to coordinate to drive down the costs. Without the claims, you’re just guessing.” In addition, Caravan offers quarterly training for care coordinators and provides a financial consultant that reviews each ACO’s financial data and how it’s doing on the 34 ACO quality metrics.

A year into the rural ACO program, both ACOs are seeing benefits. One of the ACOs decreased Medicare spending by 3 percent.

“There’s an increased focus on those patients who need it the most,” said Sara Wright, MCRH’s Rural Health Improvement Coordinator.  “The patients who overuse the ER, or are using it in an inappropriate fashion, and the patients who have multiple co-morbidities are finally getting a care coordinator who can focus on them. We also are starting to have more conversations about what factors outside clinical care affects their health, such as their home environment.”

According to Barnas, another benefit of this ACO program is that it allows waivers for transportation, durable medical equipment, and medication. For example, a transportation waiver lets hospitals help patients get to and from appointments.

“Here’s a true story,” Barnas said. “There was a diabetic patient who continued to go to the ER three or four times a month. The care coordinator did a home visit and found out that the patient’s refrigerator continuously shut down and her medication was going bad. A waiver allowed them to buy a small dorm fridge to keep her insulin safe. So the hospital spent $79 on a refrigerator instead of hundreds of dollars on continued ER visits.”

Going forward, Barnas said, because this is a three-year demonstration project, the facilities will have to decide if they want to remain in the ACOs. “If so,” he said, “we have to find a funding mechanism to continue paying Caravan Health. We’ll start engaging them in that conversation at some point this year.”