More than five years after Atul Gawande identified McAllen, Texas, as the most expensive city for health care in the United States, the city has become an example of how health reform could address such issues, according to a New York Times op-ed.
Another look: Three lessons from McAllen, Texas
In the op-ed, Farzad Mostashari— CEO of Aledade, which helps primary care organizations form ACOs, and the former national coordinator for health IT—and Bob Kocher—an Aledade investor and former health care policy special assistant to President Obama—explore how this transformation came about.
Shortly after it was published in 2009, Gawande's New Yorker article, "The Cost Conundrum," became mandatory reading at the White House and influenced the drafting of the ACA.
In the article, Gawande revealed that residents of McAllen were far less likely to receive affordable preventive care services, such as cancer screening or vaccines, but far more likely to be prescribed costly medication and undergo invasive procedures. Moreover, the residents had worse outcomes than areas with less costly care.
Changing trends
"The acid test for me is not whether the ACO program survives."
In 2012, McAllen physicians created the Rio Grande Valley Accountable Care Organization (ACO) Health Providers and signed up for the Affordable Care Act's Medicare Shared Savings Program.
The physicians analyzed data from their electronic health records to identify high-risk patients and create strategies to care for them. Additionally, physicians focused on preventive health and lifestyle changes with all their patients, focusing particularly on patients with diabetes.
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It worked, Mostashari and Kocher write. From 2012 to 2013, the number of patients able to control their diabetes increased by 11.8 percentage points. The number receiving vaccinations rose 12.2 percentage points.
And from spring 2012 to the end of 2013, the ACO saved more than $20 million from its Medicare baseline.
"A continued slowing of health care cost growth will owe a good deal to this revolution in how we pay for medical care," Mostashari and Kocher write, adding, "It is a transformation that was sparked by the Affordable Care Act, and is now being played out throughout the country—even in the little Texas city of McAllen" (Kocher/Mostashari, New York Times, 9/23).