By Richard Asinof
PROVIDENCE – Coastal Medical, a leading primary group practice in Rhode Island, and UnitedHealthcare, a health insurer serving about 250,000 state residents, announced on March 26 that it has created a new accountable care organization, or ACO, to enable primary care doctors to better manage patient health care and achieve lower costs and higher quality outcomes.
The new ACO is second such organization launched in Rhode Island by UnitedHealthcare, which joined with Lifespan last month in creating an accountable coordinated care organization, with the goal of providing the right care in the most appropriate setting.
For Coastal Medical, with more than 100 care providers in 19 locations throughout Rhode Island, the new ACO complements its ongoing “Shared Savings Medicare ACO” set up under the Centers for Medicare and Medicaid Services.
“Coastal Medical is recognized as a leader in innovative clinical initiatives that improve quality, simplify care and reduce costs. The new ACO will provide access to this model of care for nearly 190,000 of our health plan customers in Rhode Island,” said Stephen J. Farrell, CEO, UnitedHealthcare Employer & Individual of New England.
“Very good things happen in multiple places,” Dr. G Alan Kurose, president and CEO of Coastal Medical, told the Providence Business News. “This new ACO is a very positive development in the area of health delivery system and payment reform.” UnitedHealthcare’s national position in the health insurance industry, Kurose continued, as well as its national population management data analytics capacity, creates new opportunities to reduce the total cost of health care while improving its quality.
The new ACO will be overseen by a joint committee made up of representatives from both UnitedHealthcare and Coastal.
By working with the largest primary care provider group in the state, Farrelll said, it will enable the health insurer to drill down a little more in specific areas of attention as identified by Kurose.
“The primary care provider at Coastal already has a relationship with the patient, and they are able to effect change, possibly more change, more quickly,” Farrell said, in regard to health outcomes.
Kurose stressed the importance of the role that nurse care managers play as part of the patient-centered medical home model in moving patients toward better health outcomes in an ACO. “The nurse care manager, in terms of how we engage with patients, is the one who has the training and motivational interviewing skills. These are the people who design the wellness programs, the incentives for patients, who can help move the needle in behavioral change,” Kurose said.