"It's not so much something you have to do, but you can do it and save some money," DeMarco says. "Contracts will get better and savings will come back to you."
He mentions a new program in Minneapolis that provides additional primary care training to paramedics. If they're sent to a chronically ill patient, that training has paid off handsomely. Usually, the ambulance has to go to the ER first, but with additional training in primary care, paramedic crews can assess a situation and exercise judgment on whether a particular patient actually needs to go to that high-cost treatment site.
"For this paramedic program, for every dollar spent, they're getting nine dollars back," says DeMarco.
He says this example shows much of the delay in refashioning how care is delivered is not necessarily predicated on participation in ACOs or Medicare shared savings, and is misplaced.
"It gets back to the failure of clinical integration for many hospitals because they did not see it as a financial plus for them," says DeMarco. "They only saw that it would reduce the number of stays and readmissions, and would thus reduce dollars in revenue stream, therefore it was not rewarding to do it proactively. But now, they are punishing you for some of these failings."