As the U.S. health care system moves away from fee-for-service medicine to more accountable care that uses a team of health professionals, seniors covered by Medicare say they are okay with these new models that include nurses, social workers and other allied health professionals in the front lines of their treatment, according to a new analysis.
Increasingly, the Medicare health insurance program for the elderly as part of the Affordable Care Act is moving to a system that rewards doctors and hospitals for working together to improve care. By contracting with entities known as accountable care organizations and patient-centered medical homes, the providers use a team approach that can involve lower cost providers and allied health professionals to provide seniors with more attention while at the same time keeping them healthy and out of more expensive care settings.
A new national survey of adults 65 and older from the John A. Hartford Foundation about “team care and the medical home” shows 27 percent say they get this kind of care right now, they like it and it has improved their health. The openness to new models debunks theories by some in health care who think patients only want to see a doctor for all their health care needs.
The bulk of the sample, or 73 percent say they want such care and 61 percent say they believe it would improve their health. The survey, conducted for John A Hartford by PerryUndem Research/Communication, polled 1,107 adults who were age 65 or older in late January and early February of this year.
“The weaknesses of care coordination in our current system represent a clear and present danger to many older patients, causing avoidable harm, errors, complications, overtreatment, and avoidable hospital admissions and readmissions,” said Christopher Langston, program director of the John A. Hartford Foundation.
New models of health care delivery such as patient-centered medical homes and accountable care organizations emphasize the use of primary care health professionals like nurse practitioners and physician assistants and even social workers to more aggressively ensure patients are seeking regular care, taking their medicines and following their diets all in the name of keeping them out of the more expensive care setting like hospitals.
All major insurance carriers like Aetna, Cigna, Humana, UnitedHealth Group and Blue Cross and Blue Shield plans are contracting more and more with ACOs and patient centered medical homes while moving away from paying providers on a fee for service basis.
Medicare, too, is moving aggressively toward more accountable models with success achieving savings.
In the first year of the Medicare Shared Savings Program, almost half of the ACOs that started operations in 2012 had lower medical expenses than projected, exceeding their quality benchmarks, according to the Centers for Medicare & Medicaid Services. There were 29 ACOs that generated shared savings of more than $125 million.
Currently, Medicare beneficiaries are assigned an ACO through the doctor that provides most of their primary care services. As of February 2014, more than 5.3 million Medicare beneficiaries received care through an ACO model.
But accountable models like medical homes aren’t quite ready for prime time, citing studies that have questioned their results.
“Team care is still a work in progress,” Langston said.
Still, the support of seniors to a team approach means medical homes and other accountable care models have a promising future, the survey indicates.
“The fact that older adults say that team care improved their health is very significant,” Langston said. “We should build on this finding, improve the model, and make team care available to more patients who can benefit from it.”