Blog: It's not an ACO! A New York system experiments to save money, improve care

Accountable care, like political ads during a presidential campaign, is everywhere these days. And like Kristen Stewart and Robert Pattinson, the frenzy around accountable care organizations have left them overexposed.

For a change, I bring you news of health payment reform that is not accountable care. Starting in September, Kaleida Health, a Buffalo, N.Y.-based health system, will try out an alternative payment model that will put Kaleida's doctors and hospitals at financial risk for the cost of patients' avoidable medical complications.

The experiment, with Blue Cross and Blue Shield of Western New York, will test bundled payments for coronary artery bypass graft surgery using the Prometheus payment formula.

Like accountable care, bundled payments were included in the Patient Protection and Affordable Care Act. Bundled payments offer a group of providers a lump sum of money for all the care provided related to a procedure or diagnosis during a set period of time.

Prometheus, developed by the not-for-profit Health Care Incentives Improvement Institute, has been one potential model for payment bundles since its launch in 2009, albeit one that got off to a slow start as its complexity slowed its adoption.

Margaret Paroski, Kaleida Health's executive vice president and chief medical officer, described the endeavor as a “way-finding mission,” as the parties build trust and gain experience as they work to set the perimeters and establish the protocols for the pilot.

Paroski said officials selected coronary artery bypass graft surgery because its more clear-cut than care for a chronic condition, such as diabetes, and more predictable than treatment for, say, a heart attack.

Ultimately, the health system is seeking a payment model that shifts resources toward better coordinated care and fewer preventable conditions.

“We know that what we're doing right now isn't getting the results we want,” Paroski said. “This looks like a well-thought out methodology.”

You can follow Melanie Evans on Twitter: @MHmevans.