Indeed, organizations that serve low-income patients already are working to implement patient-centered medical homes. One example: Laurel Health System in Wellsboro, Pa., which operates six federally qualified health centers in rural Tioga County. Of the approximately 40,000 residents in the county, more than 6,000 are on Medicaid and between 5,000 and 6,000 are uninsured.
Laurel Health's clinics are in the midst of revamping the way they provide care to meet all of the requirements necessary to apply for certification as medical homes through the National Committee for Quality Assurance, according to Ron Butler, president and CEO of Laurel Health, which also includes Soldiers and Sailors Memorial Hospital in Wellsboro.
And O'Dell said Molina Healthcare contributes up to $10,000 toward the cost of medical-home certification for primary-care physician offices in its network.
While medical homes and integrated systems received widespread support in the survey, a much smaller percentage, 47%, of respondents said they strongly support or support the “adoption and spread of accountable care organizations.”
Why was there less support for ACOs? “A lot of people have focused on (the federal government's) proposed rule” and the criticisms of it, Bagley said.
For example, providers are concerned about the upfront costs to become an ACO and whether they will be able to offset the investment by sharing in cost savings that they generate. The CMS has estimated the upfront costs at $1.8 million, but many providers think that number is too low.
Molina Healthcare's O'Dell said safety net providers, in particular, would have trouble coming up with the money necessary to develop an ACO on their own.
Laurel Health “is up in the air like everyone else,” Butler said. “The regulations are just not clear enough yet on what the requirements are going to be.”
Butler said Laurel Health would be more likely to partner with a larger organization than to create an ACO on its own. He believes Laurel Health is well-positioned to become part of a larger ACO because the system operates many components of the healthcare continuum, including: primary care, inpatient services, behavioral health, skilled nursing, home care and hospice care.
Even if providers are uncertain about a Medicare ACO model, Bagley predicts that many providers would become part of an ACO eventually as the concept “ultimately will be in the commercial sector” as well.
But even with improvements in efficiency and accountability, the country will need to increase the number of providers who treat low-income patients beyond the traditional safety net. Implementation of the federal healthcare reform law is expected to significantly increase the number of low-income patients in the system—through Medicaid and the state-run health insurance exchanges.