A PARTNERSHIP FOR SUCCESS
About the eBrightHealth Accountable Care Organization (ACO):
In an innovative statewide partnership, the eBrightHealth ACO Shared Savings Program brings together physicians, four of Delaware’s leading health systems – Bayhealth Medical Center, Beebe Healthcare, Christiana Care Health System and Nanticoke Health Services – and Westside Family Healthcare, a federally qualified health center. 152 primary care physicians and other health care providers form the base of the ACO team that will set out on a new way of delivering care aimed to lower growth in health care costs while putting Medicare beneficiaries first.
eBrightHealth ACO partners with physician colleagues to develop a clinically integrated network. Clinical integration brings together physicians, the hospital and other health care providers to develop and sustain clinical initiatives that improve access to care, clinical quality, cost control and the patient experience by:
- Coordinating the continuum of care across affiliated caregivers, including employed, contracted and partnered community physicians
- Implementing evidence-based clinical protocols to enhance patient outcomes
- Establishing a meaningful set of quality measures to review clinical care and improve clinical performance
- Achieving efficiencies in the delivery of care
- Partnering with payors to develop contracts that drive definable clinical improvement and add value to patients.
eBrightHealth ACO at Nanticoke
Nanticoke Health Services is participating in eBrightHealth ACO, a Medicare Shared Savings Program ACO. An ACO is a group of doctors, hospitals, and/or other health care providers working together with Medicare to give you better, more coordinated service and health care. Think of an ACO as a team made up of your doctors and other health care providers. We are working together to share important information and resources about your individual needs and preferences.
Doctors and hospitals in an ACO communicate with you and with each other to make sure that you get the care you need when you’re sick, and the support you need to stay healthy.
Your Medicare benefits aren’t changing. ACOs are not a Medicare Advantage plan, an HMO plan, or an insurance plan of any kind. You still have the right to use any doctor or hospital that accepts Medicare, at any time. Your doctor may recommend that you see particular doctors or health care providers, but it’s always your choice about what doctors and providers you use or hospitals you visit.
To help eBrightHealth ACO give you better, coordinated care, Medicare will share information with us about your care. The information will include things like dates and times you visited a doctor or hospital, your medical conditions, and a list of past and current prescriptions.
This information from other healthcare providers will give Nanticoke Memorial Hospital and other healthcare providers in the ACO a more complete and up-to-date picture of your health.
If you choose to let Medicare share your health care information with Christiana Care Quality Partners ACO, it may also be shared with other ACOs in which your other doctors or healthcare providers participate. If you don’t want your health care information shared, you can ask Medicare not share it.
Just like Medicare, ACOs must put important safeguards in place to make sure all your health care information is safe. ACOs respect your choice on the use of your health care information for care coordination and quality improvement.
Yes, share my information: If you want Medicare to share information about care you have received with us and with other ACOs in which any of your doctors or other healthcare providers participate, then there’s nothing more you need to do.
No, please don’t share my information: If you don’t want Medicare to share information with eBrightHealth ACO or with any other ACOs for care coordination and quality improvement purposes, you must do the following:
- Call 1-800-MEDICARE (1-800-633-4227). Tell the representative you are calling about ACOs and that you do not want Medicare to share your health care information with ACOs. TTY users should call 1-877-486-2048.
- If you change your mind in the future, call 1-800-MEDICARE and tell the representative what you have decided. We can’t communicate with Medicare on your behalf.
Even if you decline to share your health care information, Medicare will still use your information for some purposes, including certain financial calculations and determining the quality of care given by your healthcare providers participating in ACOs. Also, Medicare may share some of your health care information with ACOs when measuring the quality of care given by healthcare providers participating in ACOs.
If you have questions or concerns, call us at 302-536-5272, or we can discuss them next time you’re in our office. You also can call 1-800-MEDICARE and tell the representative you’re calling to learn more about ACOs, or visit Medicare.gov/acos.html.
Better care, better health, better cost
Consistent with national trends, the eBrightHealth ACO intends to structure reimbursement models to incorporate performance and value-based pay methods to focus on achieving quality, efficiency and cost-management measures.
Many observers describe the current health care environment as a “magic moment in time” due to the opportunity it presents to transform the health care delivery landscape. Nanticoke Health Services believes there is no better moment to partner on a new model of care that aligns with the Triple Aim championed by the Institute for Healthcare Improvement:
- Produce better care for individuals
- Produce better health for populations
- Lower per capita health care costs
Benefits of a clinically-integrated network:
- Improved safety
- Improved quality of health care
- Better access to the latest proven techniques and treatments
- Streamlined interactions with health care system—less waiting and duplication
- Fully informed physicians and medical staff
- Access to complete patient information
- Ability to deliver higher quality care
- Ability to monitor patient compliance
- Ability to sell combined services of network to payors, making independent practice more viable, especially for small practices
- Higher degree of effective collaboration
- Improved clinical quality and patient safety
- Base of independent physicians aligned with hospital
- Ability to manage costs
- Differentiation in the market as high quality provider
- Higher subscriber satisfaction
- Cost efficiencies and savings
- Higher quality health care for subscribers
- Easy access to objective utilization data
- Containment of health care costs
- Healthier employees Community
- Ability to maintain independent physician practices
- Better health care
- Ability to recruit medical talent to area
- Reduced costs