Pioneer Accountable Care Organization: A Surprise Moneysaver

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Nationwide, Pioneer ACOs saved the government $96 million last year, compared with $87.6 million in 2012, the Centers for Medicare and Medicaid Services said last month.

The social worker pulls on blue latex gloves and a surgical face mask. She steps into the hospital room, where sheer curtains dim the September afternoon sunlight.

James Watley, 53, sits upright in bed, recovering from a bone marrow transplant. He’s sipping ginger ale through a straw. An orange rests at his hip, as though he’s guarding it. Unprompted, Watley makes his case to stay. “I can’t go back,” he tells her, softly. “This is it. The last stand. Next one’s the box.”

He came here from a Brooklyn homeless shelter, where his oxygen tank was considered a fire hazard. It’s at least an hour by subway from the Montefiore Medical Center in the Northwest Bronx, where he receives treatment for blood cancer. Last time, he fainted on the train.


Deirdre Sekulic, 42, doesn’t argue. Her job is guided by one belief: Sick people with no home cannot heal. Moral implications aside, that’s an expensive problem for the nation.

“I might have an opportunity for you,” she says. “It could take a while, and it’s hard to tell what will happen. . . . But I need to know you’re interested.”

Sekulic heads Montefiore’s housing unit, which aims to find one-bedroom apartments for homeless patients who show up in the emergency room, again and again. The program is the only one of its kind in New York City.

Montefiore is also an unexpected cost-saving offshoot of the Affordable Care Act — and part of an experimental effort to treat health care as more than just medicine. The dual goal: Save lives, save money.

The medical center is what’s called a Pioneer Accountable Care Organization, one of 19 in the country. More simply: It’s a network of doctors, nurses and social workers who team up to deliver continuous, coordinated care to patients — and, in the process, slash government spending.

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