Two state doctors’ networks named to oversee care, cost for Medicare patients

The federal government has designated two Connecticut doctor networks as “accountable care organizations” responsible for controlling costs and providing more coordinated medical care for Medicare patients.

PriMed Inc. of Shelton and MPS ACO Physicians LLC of Middletown were among 89 designated as ACOs nationally Monday by the federal government.

These ACOs, part of the Affordable Care Act, will be responsible for coordinating care between primary care doctors and specialists to make sure patients get quality health care while avoiding duplication of services and unnecessary emergency room visits. As a financial incentive, the federal government will split the cost savings with the ACOs.

Douglas S. Arnold, the CEO of MPS ACO Physicians, said the federal government spends an estimated $13,400 a year on each Medicare patient in Connecticut. The ACO and the federal government could, for instance, save money by avoiding duplicate services done by different specialists and by better managing trips to the ER.

He used an example of a fictional 75-year-old man with diabetes, coronary artery disease, COPD and other ailments who experiences shortness of breath. He calls his doctor’s office but they are about to close for the day. Rather than being told to go to the emergency room, a coordinated care provider could, for example, arrange to keep the doctor’s office open later and even possibly pick up the patient and drive him to the office. There, the patient would be examined and health records checked to see whether the problem could be something as simple as, say, a side-effect of a new medicine, Arnold said.

Such an approach would be more efficient than possibly waiting for hours in an emergency room, undergoing costly tests and possibly being admitted to the hospital, he said.

Despite the strong incentive to cut costs, Arnold said ACOs would not skimp on medical services for Medicare patients.

“The incentive is to make sure necessary services are provided, but better coordinated so they are the most appropriate,” Arnold said.

He said Medicare patients would still get to choose their own doctors and specialists.