Better patient care, at a lower cost? A Philadelphia-area primary care doctor is testing new models to improve health care

The Affordable Care Act expanded health insurance coverage to millions of Americans through Medicaid expansion and subsidies for individual plans. When President Barack Obama’s landmark legislation passed in 2010, it also created initiatives to slow the growth of the nation’s health-care tab, in part by reducing wasteful spending.

One initiative, the Medicare Shared Savings Program, allows hospital systems and doctors’ groups, acting through Accountable Care Organizations (ACOs), to earn bonuses.

The model depends on health-care providers finding ways to trim costs, largely by avoiding hospitalizations and emergency department visits. Yet when that happens, hospitals lose revenue. The dynamic creates conflicts of interest, said Amol Navathe, an associate professor of health policy and medicine at the University of Pennsylvania.

“Different parts of the organization end up working kind of in tension with each other,” Navathe said of hospital-system based ACOs. “On the physician side, it’s cleaner.”