As an emergency department physician, Dr. Mark Fourre has spent much of his career treating medical crises that could have been avoided.

The result of those crises is high medical bills and bad health outcomes: an infection leads to an amputation that could have been avoided with better diabetes care; a patient’s heart is permanently weakened by a heart attack that could have been prevented with better diet and exercise.

The flaws in the current medical system and the need to develop new medical models that can provide care more efficiently are the reason Fourre, the medical director of Lincoln Medical Partners, has been actively involved in the development of the new MaineHealth Accountable Care Organization.

The MaineHealth ACO is the largest of three new Maine ACOs announced July 9 by the Centers for Medicaid & Medicare Services. Lincoln County Healthcare, which includes Miles Memorial Hospital and St. Andrews Hospital, is part of that ACO. Nationally, 89 organizations were selected to participate in the program for three years beginning July 1.

Accountable Care Organizations are groups of providers who work together to care for a population of patients. The goal of an ACO is to improve the patient experience, to improve the health of the community and to lower costs.

The MaineHealth Accountable Care Organization includes 1,595 physicians and will offer coverage to about 35,000 Medicare patients under the federal government’s Medicare Shared Savings Program, which is part of the 2010 healthcare overhaul. 

That program gives doctors more responsibility for coordinating patient care. In return, the ACO will try to offer better care more efficiently. If the ACO is able to both save money and meet or exceed quality and safety guidelines, it can keep part of the money saved.

Fourre said the formation of the ACO is driven by a growing gap between the cost of care and the resources available to pay for that care, particularly from government insurance programs Medicare and MaineCare.

Unless providers are able to change the rules of the system, that gap will inevitably lead to lower quality care. 

Fourre said as part of an ACO, doctors have an opportunity to better coordinate care and the flexibility to lower costs by spending more time on the preventative care that helps people avoid the medical crises that result in poor outcomes and high medical bills.

By itself, Lincoln County Healthcare is too small to form an ACO, but as part of the MaineHealth ACO, it can provide a full spectrum of high quality services to keep the community healthy while ensuring that care remains both affordable and accessible.

MaineHealth is the largest integrated healthcare network in Maine and is ranked among the top 100 best-performing healthcare systems in the nation for offering high quality and efficient care.

Southern and coastal Maine (including Lincoln County), is one of 10 places in the United States that has been found to offer high quality care while spending relatively little per Medicare patient, according to www.dartmouthatlas.com.

As a rural healthcare system that employs the vast majority of physicians in the area, Lincoln County Healthcare also has a network of primary care providers.

Primary care providers and their relationships with patients will be at the core of the new ACO.

Improving communication between providers and patients so that patients make better decisions about their care is one of the most important ways the new ACO will improve efficiency.

“The challenge is simply giving people information so they can make the right choice,” Fourre said.

That means investing in primary care and it means investing in the conversation between provider and patient. Over time, it also means developing a more team-based model of primary care. That change will evolve slowly. Initially, patients will likely notice no change and then only incremental changes as the ACO develops over the next five years or so.

Patients will spend more time during their primary care visits but not all of that time will be spent with doctors. They may also spend time with a nurse talking about diet and exercise, or a diabetes educator.

Those conversations can help avoid high-cost interventions one, two or five years later, Fourre said. That means costs are lower, outcomes are better and the patient is healthier and better cared for.

“Everybody is happier. The provider is happier and it is better for the patient,” he said.

As the new Medicare ACO is able to improve care and lower costs, Fourre believes more healthcare payers, including private insurance companies, will go to an ACO model. Adapting to that reality means that Lincoln County Healthcare will have to become more efficient. That is a difficult challenge but a necessary one.

With the resources available for healthcare projected to decline well into the future, Fourre said the future of small rural health systems like Lincoln County Healthcare is not bright under the current model. As part of a MaineHealth ACO committed to keeping patients well and lowering costs, however, the future is bright for both Lincoln County Healthcare and its community.