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IN TERVIEW be savings that can be shared with the health system. Patients may have lower out-of-pocket expenses with improved coordination of services. How are these effects achieved? Participating in this ACO challenges us to work together as providers and with our patients to reevaluate and redesign care. The Center for Medicare and Medicaid Services has established quality measures on care coordination and patient safety, the appropriate use of preventive health services, improved care for at-risk populations such as diabetics, and patient and caregiver experience of care. Many of these quality measures will eventually be reported on public websites, and this transparency is a strong motivator for change when needed. There is general agreement that in healthcare there has been a certain amount of waste — ordering tests that aren’t needed, for example — and a need to emphasize patient safety. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary or duplicative services and preventing medical errors. is evidence-based and not wasteful, we are placing much more emphasis on patient preferences in developing those standards. Healthcare has traditionally been organized around the needs of doctors and hospitals. Now, rather than creating a care plan and telling the patient what’s going to happen, we’re designing plans that meet patient desires and also have the ability to respond to individual patient preferences. We are emphasizing shared decision making. In doing so, we believe the quality of care will improve, patients will be more satisfied and costs may be reduced. What changes have taken place so far? We have implemented our care-coordination model in the primary-care practices and we are now working to redesign care across the specialties. We have initiated programs to better understand the cost of care and to determine where there are opportunities to reduce costs and eliminate unnecessary services. We have also made large investments in expanding the primary-care network to improve access. How is the patient experience improved through an ACO? UCLA is one of the few academic medical centers to participate in the Medicare Shared Savings Plan by forming its own ACO. What was behind the decision? One way is by increasing the ability of patients to more fully understand and express their preferences for the care they receive, to help patients and their doctors make better choices. At the same time that we are standardizing care to make sure it In a sense, UCLA is an unusual participant in that we are not an independent group of doctors or hospitals getting together to do this. We have always practiced as an integrated group. And we have always emphasized coordinated, high-quality care. But we recognize that as an organization we can improve, especially as we are being challenged to do more for our patients while keeping the cost of care in mind. We see this as part of the future direction of healthcare, and we are excited to be in on the ground floor of these important changes. To view a video to ﬁnd out what an ACO is, go to: uclahealth.org/aco Samuel A. Skootsky, MD Vital Signs Summer 2014 Vol. 63 9