Questions & Answers about POM ACO

On January 1, 2013, nine physician groups launched an Accountable Care Organization under the Medicare Shared Savings Program, called the Physician Organization of Michigan ACO, or POM ACO. In early 2014, POM ACO expanded to include all U-M faculty physicians, and thousands of other providers from UMHS and across the state.

Here are some quesions and answers about the new organization. For more, visit www.pom-aco.com. 

 

Q: What is Physician Organization of Michigan ACO (“POM ACO”)?

A: Simply put, it’s a group of quality-minded physicians, from 12 physician organizations around Michigan, who have come together to take part in a Medicare-sponsored program that seeks to improve the quality of care for traditional Medicare beneficiaries while also containing cost growth.

Accountable care organizations, or ACOs, were authorized under the federal health care reform law, the Patient Protection and Affordable Care Act. Hundreds of ACOs have formed nationwide, and POM ACO is one of the largest.

 

Q: Who’s involved?

A: More than 5,700 physicians and other providers with offices in 22 counties across the state. Together, they care for 120,000 patients who are enrolled in traditional “fee for service” Medicare, either as their primary care doctors or as the specialist who leads the management of a significant chronic illness. (See more about what POM ACO means for patients below.)

 

Q: What’s the University of Michigan’s role?

A: U-M is a national leader in the ACO movement, and helped prove that this approach to care can improve quality while containing costs. That proof, in a five-year Medicare Physician Group Practice (PGP) demonstration project that the U-M Medical School’s Faculty Group Practice took part in, became the prototype for ACOs in the Affordable Care Act. U-M’s own doctors also formed an ACO with another local physician group under the Pioneer ACO program, but all members of that ACO have now transitioned into POM ACO.

 

Q: Why is U-M involved?

A: POM ACO is consistent with the U-M Health System’s mission of being a statewide resource and its strategic goal of translating knowledge into practices and policies that improve health status and access to appropriate care, by developing clinical partnerships and population management capabilities.

 

Q: How did POM ACO come to be?

A: POM ACO grew out of discussions that U-M leaders had with physician groups around the state, after the formation of the Physician Organization of Michigan with U-M’s partner the Physician Organization of West Michigan. Many quality-minded physician groups and individual physicians wanted to get involved in the ACO movement, but did not have the resources to do so alone. The group submitted a proposal to the Centers for Medicare & Medicaid Services to become an ACO under the Medicare Shared Savings Program, and that proposal was accepted as of Jan. 1, 2013. In early 2014, the Centers for Medicare and Medicaid Services accepted the applications of U-M physicians and other providers, and of other doctors from around the state, to join POM ACO.

 

Q:  How is POM ACO structured?

A: Officially, it’s an LLC owned jointly by U-M and the participating physician groups. U-M holds a majority interest through the Michigan Health Corporation, the entity that allows the U-M Health System to enter into outside partnerships. The intention is for POM ACO to be overseen by a board composed mainly of physicians from each participating group. The physician groups will coordinate data and programs for their member physicians who are participating in POM ACO.

 

Q: What does POM ACO mean for patients?

A: The 120,000 patients who have traditional Medicare coverage and whose doctors have joined POM ACO will keep their doctors. Any differences in their care will be positive ones, as their doctors ensure that they provide patients with proven preventive care and treatments for their conditions.

Doctors will work to meet or exceed benchmarks for conditions and services that Medicare focuses on – and will get feedback on how well they’re doing. Over time, patients may be offered the opportunity to take part in programs that can help them manage their health, or offer them assistance between doctor’s appointments.

Medicare participants whose doctors are in POM ACO will receive a letter explaining the program further, and giving contact information.

 

Q: Will doctors make money from the program?

A: POM ACO is part of a ‘shared savings’ program launched by the Centers for Medicare and Medicaid Services, and it includes provisions for participating physicians and physician groups to share in savings that they achieve for traditional Medicare – but only if they meet specific goals for care quality and coordination. They also must achieve more than a 2 percent savings compared with what their patients’ care would have been expected to cost, according to Medicare calculations.

Cost savings can come from reducing redundant or unnecessary care, preventing hospitalizations or re-hospitalizations, and providing services that can prevent or delay complications of chronic disease.