Better healthcare for less money, if you can find it

Consumers intrigued by the new model of accountable healthcare - which promises better-coordinated care that could save lots of money - are going to have to actively seek out participating providers.

A tenet of accountable care is better quality: doctors are paid to keep patients healthy, rather than for treating them when they are sick. Some programs even penalize providers for too many hospitalizations or not keeping overall costs down.

The changes are being driven by the Affordable Care Act, otherwise known as Obamacare, which calls for experimentation in cost-cutting for Medicare.

The narrowest definition of an accountable care organization is one that is on a list of about 250 officially participating in a Medicare pilot program. But not all are at the same stage of implementation, and there is also a growing list of others adopting the model.

What it means for patients is that they have one caregiver looking out for them.

The difference from seeing a doctor on a traditional fee-for-service plan was immediately apparent to Dennis Chitwood, a 71-year-old, retired salesman who lives in St. Louis. His current insurer, Essence Healthcare, a Medicare Advantage service provider, is an independent accountable care organization.

The first thing Chitwood noticed was that his doctor spends more time with him during appointments, and readily handed over his email address and cell phone number.

"It's like having a personal trainer or coach," says Chitwood. "Nothing seems to be too small for him to talk about."

The number of consumers touched in some way by accountable care models adds up to 43 million, or about 14 percent of the market right now, according to Niyum Gandhi, an associate partner at consulting firm Oliver Wyman. Some 230 ACOs operate under Medicare's Shared Saving Program, and 32 were in its experimental Pioneer program launched last year. The number continuing to the second year is in flux.

There are also some 50 to 60 are publicly-announced private groups, and dozens of others that follow similar methods but don't necessarily align themselves with any formal program. Overall, there were 449 ACOs and ACO-like entities in March, which is up from about 10 in 2010, according David Muhlestein, director of research for consulting firm Leavitt Partners.

MODEL NUMBERS

There is no easy way for consumers to identify accountable care groups - even the experts have a tough time tracking them - but there are a few questions you can ask to discover where your caregiver falls on the spectrum.

Find out if your primary care doctor is going to be responsible in some way for your overall care, either by meeting shared savings goals or quality benchmarks. Seek out a doctor who has a stake in keeping you healthy and who is going to shepherd you through the healthcare system, Muhlestein says.