The patient’s daughter called toward the end of office hours, fearing her mother, a diabetic, had experienced a stroke. The nurse practitioner — who had established a relationship with the patient — listened carefully to the symptoms and asked very specific questions before determining the elderly patient probably did not have a stroke but should come to the office right away. She asked a physician to stay late that night.

The mother, it turns out, took insulin but then did not eat any food for several hours. Her blood sugar dropped, causing her to feel lightheaded. The fix was easy as the doctor gave the patient sugar. That evening the elderly woman went back to her own home — and not to a hospital ER to undergo unnecessary tests.

I listened to this story while I was interviewing Dr. Peter A. Gross for a live interview arranged by The American Journal of Managed Care. Dr. Gross is part of the leadership of the HackensackAlliance ACO and he outlined the case to show how the collaboration operates to both reduce costs and improve patient care.

The Alliance is included in the 31 percent of ACOs in the Medicare Shared Savings program that has successfully reduced costs while also improving care. The Hackensack ACO received high scores on quality measures while also reducing the overall cost to care for their patients. Dr. Gross talked about cutting fat in the system. Do so many patients really need to be transported to dialysis by ambulance? What about letting patients in skilled nursing centers go home when they are ready — even if Medicare will pay for additional days? And should physicians spend more time explaining to patients in pain that opioids do not provide long-term relief and that alternatives exist?

The HackensackAlliance ACO worked with physicians, nursing homes, rehabilitation centers and other providers to explore how together they could reduce the 30 percent waste that the Institute of Medicine says we have in our health care system. According to Dr. Gross, the key decision behind the ACO’s success was to require the primary care providers in the ACO to achieve Patient Centered Medical Home recognition for their practice and operational electronic health records within a year of joining the ACO.  These requirements support team-based comprehensive care. The practices tracked each patient’s needs and also reached out when necessary to make sure the care was coordinated and managed by the practice.

The first year the HackensackAlliance saved Medicare $10 million; the second year the savings were $6 million; and for 2015, it was a whopping $33 million. And because the ACO’s score on 33 quality measures last year was 96 percent, they received a larger portion of the savings.

As many in health care bristle at the changes ahead, I love that a physician in his 70s who has practiced for more than four decades is one of the people showing us the future.

And the stakes are high for America’s physicians. Next year, those who do not participate in an eligible alternative payment program will soon have to report quality and other measures to Medicare.  By 2019, those who do well on those measures will receive upward adjustments to their payments but those who do not will see their Medicare fee-for-service rates decrease.

Far from resisting change, when I asked Dr. Gross how he felt about the push toward outcome-based payments, he said, “Well, I’m excited. Who wouldn’t be excited? I think this all makes a great deal of sense. It’s simply the right thing to do.”

I want to thank The American Journal of Managed Care for arranging the interview and advise you all to listen here.