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    COPD one of ‘most important’ diagnoses to manage in ACOs


    The two major goals of the Next Generation Accountable Care Organization Model (NGACO Model) are to improve health outcomes and lower expenditures by providing incentives to ACOs. This type of ACO carries more risk for participants than HHS’ Shared Savings ACOs, but the potential rewards are also higher.

    In January, Indiana University Health in Indianapolis entered into the NGACO Model. To ascertain how the model might impact treatment of patients with chronic obstructive pulmonary disease (COPD), Managed Healthcare Executive (MHE) asked Richard Bernhardt, MD, medical director of population health for Indiana University Health Physicians, to share his thoughts.

    MHE: Does COPD present a particular challenge with the NGACO Model?

    BernhardtBernhardtBernhardt: It is no surprise that the evidence demonstrates that COPD is probably one of the most important diagnoses we truly need to get a handle around as we manage populations, specifically in an ACO Medicare population.

    We felt that while all of our primary care physicians were using evidence-based practice to their best ability, this practice had wide variation in caring for COPD, especially working inside a healthcare system.

    As a result, earlier this year we partnered with a pulmonologist from Indiana University School of Medicine who had a published study within the past five years that placed COPD patients in a very prescribed program and followed them over time compared to a matched cohort. This was the foundation for us writing what we call our COPD playbook.

    MHE: What are the highlights of your COPD playbook?  

    Bernhardt: There is a clinical portion describing how you should care for COPD patients, which lines up very well with international guidelines. There is also a section on how we navigate a COPD patient through our system and best leverage our resources.

    One area we looked at was pulmonary function testing. What do our primary care doctors really know about ordering this testing? What are the specifics you should order to effectively receive what you need right away? We found a major gap in knowledge.

    Similarly, when should you refer a COPD patient to a pulmonologist? Do pulmonologists want to see patients earlier or later? It kind of depends on your system resources. But we want our primary care physicians to be prepared ahead of time so a patient does not a waste a visit with a pulmonologist.

    Next: How will these proactive steps benefit the NGACO model? 



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