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Presbyterian Healthcare Services, UnitedHealthcare to form accountable care organization

The partnership follows work by both to help shift New Mexico’s healthcare to a value-based model.

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New Mexico-based Presbyterian Healthcare Services and UnitedHealthcare this week said they will launch an accountable care organization.

Presbyterian Healthcare Services, an integrated delivery system with eight hospitals, 700 physicians, 100-plus clinics and a 300,000-member health plan, will take on care coordination and prevention for more than 12,000 members in UnitedHealthcare’s employer-sponsored plans in New Mexico.

“Presbyterian is focused on improving the health of the patients and members we serve,” said Kathy Davis, RN, senior vice president and chief nursing officer at Presbyterian Healthcare Services. “This partnership aligns with our emphasis on improving the quality and coordination of care. By focusing on several key quality measures, we hope to make a significant impact on patient health.”

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The partnership follows work by both Presbyterian and United, who each run competing Medicaid managed care plans, to help shift New Mexico’s healthcare system to a value-based model.

In the deal — one of 250 ACOs for United — Presbyterian providers will be eligible for payment incentives based on patient satisfaction, achieving evidence-based measures such as preventing readmissions and managing chronic conditions, as well as total cost savings.

UnitedHealthcare will try to complement Presbyterian’s own data with additional support aimed at population health, for instance with data on patient profiles, quality gaps, and real-time emergency and inpatient admissions. United said the plans may also use patient navigators for community-based care coordination.

“Our ACO partnership with Presbyterian Healthcare Services enables us to connect the people we serve to the right, most effective care, place a greater focus on care quality, and compensate care providers for improving patients’ health,” said Beth Soberg, president and CEO of UnitedHealthcare in New Mexico, in a statement.

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UnitedHealthcare’s total payments to physicians and hospitals that are tied to value-based arrangements have almost tripled since 2012, to $38 billion. By the end of 2018, the company hopes to reach $65 billion, more than half of its total 2014 revenue. Presbyterian has also been seeking to expand in value-based reimbursement and now has two-thirds of operating revenue tied to value-based arrangements.

Twitter: @AnthonyBrino