Accountable Care organizations recognized for working toward the triple aim

Imagine getting a diagnosis, but instead of receiving a prescription or scheduling follow-up care, you’re told that your treatment plan is a healthier lifestyle. Donna Manfredi found herself in this very scenario after struggling to control her Type 2 diabetes. The 61-year-old from Rhode Island, knew her blood sugar levels were way too high, but she had always ignored advice to change her lifestyle. 

For Donna, things changed when she began receiving care at Rhode Island Primary Care Physicians Corporation (RIPCPC). Her doctor told her she was close to having to go on dialysis to maintain her kidneys. But this time, she didn’t leave her doctor’s appointment with only a healthy dose of worry. She left with a plan.

Donna began working with Danielle Phenix, a nurse case manager, who helped educate and support her as she started making changes to her routine.

Initially, they talked on the phone three to four times a week. Donna would ask about food choices and keep Danielle updated when she had success with healthier alternatives she’d been trying, like zucchini noodles and cauliflower gnocchi. Danielle kept her motivated and held her accountable. 

After transitioning to healthier eating and increased exercise habits, Donna started shedding pounds and lowering her blood sugar levels. She is down more than 30 pounds, and her blood sugar levels have dropped significantly.

This is exactly the type of outcome RIPCPC was aiming for when they established a core team of physicians, nurse case managers like Danielle, psychologists, social workers and patient managers to provide whole-person care. This transformation in their system of care was designed to better address the needs of patients like Donna. 

“I believe if Danielle wasn’t there, I would not have done it. I would not have succeeded – not without her help,” Donna said.

This is an example of how change in health care is happening. People want lower costs and higher quality, but it’s hard to achieve this outcome with the long-used fee-for-service model, which emphasizes quantity of treatments over quality. 

One solution to bring change is through Accountable Care Organizations (ACOs), like RIPCPC. ACOs are groups of providers and hospitals that work together to increase the quality of care and improve the patient experience while lowering costs. That cost reduction is made possible when the ACOs take accountability for the health outcomes of their patients. Providers that participate in ACOs agree to be reimbursed based on the quality of care they provide and their patients’ health outcomes. 

ACOs hold tremendous promise to address some of the major issues plaguing the U.S. health care system, namely the rapidly rising costs of care. That’s what prompted UnitedHealthcare to establish its Accountable Care Summit, where it convenes more than 100 of its ACO partners to share best practices and celebrate those partners that have demonstrated significant success with their models.

At this year’s summit, held in June, UnitedHealthcare presented awards to five of its ACO partners, one for each of the company’s core values: integrity, compassion, innovation, relationships and performance.

Located in Virginia, Privia Health received recognition for using data to refer patients to the highest quality doctor for the best price.

Mountain Park Health Center, located in Arizona, earned its award for identifying a critical barrier to care: transportation. The transportation vendor previously required a 72-hour notice for rides to be arranged for provider visits. This didn’t work for same-day visits, so patients would default to calling an ambulance and going to the emergency room instead. Mountain Park started paying out of its own pocket to provide patients with cab rides for same-day care, which reduced the readmission rate.

Rhode Island Primary Care received recognition after engaging in six pilot programs with UnitedHealthcare in 2019, focused on the integral role pharmacists can play in the patient experience.

BayCare, in Florida, earned recognition for improving the experience for patients transitioning into Medicare with additional outreach and follow-ups from its nurse team, which improved the readmission rate.

UnityPoint Health, located in Iowa, received its award for its high-quality member experience for Medicare patients. By enhancing technology, leveraging data and adopting new policies, new Medicare patients were seen sooner, and care gaps were recognized and addressed.