Will ACO's replace HMO's

March 12, 2012
Small-Picture Approach Flips Medical Economics
By BRUCE JAPSEN
CHICAGO — Even as she struggled to manage her Type 2 diabetes, Fannie Cline’s condition spiraled downward. It was not uncommon for Mrs. Cline, a 69-year-old retiree, to have dizzy spells, some so bad that they landed her in a hospital emergency room near her home here on the South Side.

But last May, she began to receive extra attention from Gwlie Lloyd, a registered nurse and care manager at Advocate Health Care, which operates a number of Chicago hospitals and clinics. Ms. Lloyd frequently calls to check on Mrs. Cline; she offers advice on diet and exercise, schedules appointments, orders meals for delivery and arranges appointments with a social worker.

As a result, Mrs. Cline’s health has markedly improved. She is more active, the dizzy spells have subsided and she has not been hospitalized since May. Now she spends her days visiting friends.

“It is nice to have someone call you in between your visits to the doctor’s office to see how you are,” Mrs. Cline said. “If my blood sugar is elevated and I feel off balance, she will ask me what I have been eating lately. She might say, ‘Maybe you need more oatmeal or fruit.’ ”

The extra attention Mrs. Cline receives is the result of a radical departure from traditional fee-for-service medicine. Advocate runs one of the nation’s first and largest accountable care organizations, a new kind of health care practice gaining momentum in part because of the Affordable Care Act signed into law two years ago by President Obama. . .