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Coastal Medical is First Medicare Shared Savings ACO in Rhode Island

PROVIDENCE, RI (July 9, 2012) – Coastal Medical today announced it has been selected to participate in the Medicare Shared Savings Program, a multifaceted new program sponsored by the Centers for Medicare and Medicaid Services (CMS) under the Affordable Care Act.

The Medicare Shared Savings Program is designed to encourage better coordination of care for Medicare patients, so that patients receive the right care at the right time, without duplication of services or medical errors.  Participating organizations are required to function as a new type of health care entity referred to as an “accountable care organization” (ACO) that agrees to be held accountable for improving the health and experience of care for individuals, while also improving the health of populations and reducing the rate of growth in health care spending.  

In this new program, helping patients to navigate a complex health care system effectively is a top priority, and Coastal providers will work hand‐in‐hand with every patient to ensure a seamless transition of care when specialty care, emergency care, hospitalization, or home care is required.  This type of “coordination of care” has been shown to positively impact health outcomes while also reducing global costs of care, and the Medicare Shared Savings Program offers incentives, via a share in cost savings, to organizations that successfully provide coordinated care.  Specifically, if the new model of care generates savings for CMS, Coastal will be eligible to share in those savings - but only if measurements of the quality of care delivered by Coastal meet the performance standards put forth by CMS.  Those standards include measurements of care coordination, patient experience of care, preventive health care, and care of patients with specific chronic illnesses.

Patients served by the Coastal Medical ACO will continue to have freedom of choice regarding the type of care they receive and the providers they chose to visit, without regard to whether a particular provider is participating in an ACO.

“The goals of the ACO - improved care coordination, better health outcomes, improved patient experience and reduced costs - are perfectly aligned with Coastal’s ongoing mission of transforming the delivery of healthcare for our entire population of patients,” said Al Kurose, MD, President and CEO, Coastal Medical.  “This opportunity to function as an ACO within the Medicare Shared Savings Program is very similar to our opportunity to care for patients under the shared savings contract we signed with Blue Cross Blue Shield of Rhode Island earlier this year.” “ACO’s encourage providers to work more closely together than ever before, resulting in better care and more cost effective care for every patient.”

A second component of the CMS Medicare Shared Savings Program is the opportunity for certain ACO’s chosen for the Shared Savings Program to be considered for an advanced payment from CMS to help cover the costs of establishing the infrastructure needed to coordinate care for the beneficiaries they serve.  The advance payments will be repaid from shared savings eventually earned by the ACO.  CMS is expected to announce soon which ACOs will receive the advanced payment option.

For more information contact:
Kim McHale
401) 421-4000 ext: 244

Coastal Medical, Inc. is a medical service organization and the state’s largest primary care group practice consisting of 91 providers with 17 medical offices across Rhode Island. Coastal provides predominantly primary care, along with some specialty services, to 105,000 patients. Coastal also owns a successful laboratory and imaging center, and provides practice management solutions to physician practices and hospital systems across the country.