Com­plex co­or­di­na­tion

Suc­cess­ful Pi­o­neers credit fo­cus on im­prov­ing care

Modern Healthcare - - COVER STORY - Me­lanie Evans and Jessica Zig­mond

Medi­care Pi­o­neer ACOs that saved money on pa­tient care—and will share Medi­care’s $140 mil­lion in to­tal sav­ings for 2012—credit their suc­cess to an in­tense fo­cus on im­prov­ing co­or­di­na­tion and care for the most com­plex and costly pa­tients.

One Pi­o­neer suc­cess story is New York City-based Mon­te­fiore Med­i­cal Cen­ter, which op­er­ates one of the 32 Pi­o­neer ACOs launched last year by the Cen­ter for Medi­care and Med­i­caid In­no­va­tion, which was cre­ated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act. Mon­te­fiore, with 23,000 en­rollees, will re­ceive $14 mil­lion from Medi­care.

Bos­ton-based Part­ners Health­Care, with 52,000 pa­tients, will re­ceive $14.4 mil­lion in shared sav­ings. Phoenix-based Ban­ner Health Net­work will get $13 mil­lion for its man­age­ment of about 50,500 pa­tients. Also in Bos­ton, Beth Is­rael Dea­coness Care Or­ga­ni­za­tion claimed a pay­out of nearly $7.8 mil­lion af­ter bring­ing spend­ing un­der bud­get for 30,000 Medi­care pa­tients. And In­di­anapolis­based Fran­cis­can Al­liance ACO, with 20,000 en­rollees, will pocket $6.6 mil­lion.

In to­tal, 13 Pi­o­neer ACOs will re­ceive a com­bined $76.1 mil­lion be­cause of their cost­sav­ing suc­cess in the first year of the Pi­o­neer ef­fort. An­other five Pi­o­neers also saved Medi­care money, but not enough to earn bonus pay­outs.

Steve Rosen­thal, vice pres­i­dent and chief op­er­at­ing of­fi­cer for Mon­te­fiore’s case man­age­ment op­er­a­tions, said his or­ga­ni­za­tion’s ACO was able to “zero in very quickly” on the roughly 2,000 pa­tients who ac­counted for nearly half the group’s med­i­cal costs.

Care man­agers were paired with Mon­te­fiore’s high-risk pa­tients to iden­tify their needs and how to fix them, he said. For pa­tients with con­ges­tive heart fail­ure, Mon­te­fiore used high­tech scales in pa­tients’ homes to de­tect weight gain, which can sig­nal a wors­en­ing con­di­tion. Ed­u­ca­tors were as­signed to di­a­betes pa­tients to help them learn more about their dis­ease. Hos­pi­tal stays dropped, ac­count­ing for most of the sav­ings the ACO achieved.

At the Fran­cis­can Al­liance, Jay Brehm, se­nior vice pres­i­dent of strate­gic plan­ning

and busi­ness de­vel­op­ment, also cred­ited sav­ings to in­vest­ments in care co­or­di­na­tion, chronic dis­ease case man­age­ment and im­proved com­mu­ni­ca­tion. He de­scribed the Pi­o­neer ef­fort as in­te­gral to re­design­ing its de­liv­ery sys­tem.

“This is par­tic­u­larly crit­i­cal as we move away from fee-for-ser­vice medicine to­ward a sys­tem fo­cused on cre­at­ing greater value for pa­tients and bet­ter­ing pop­u­la­tion health,” he said in a writ­ten state­ment.

Dr. Richard Parker, chief med­i­cal of­fi­cer for Beth Is­rael Dea­coness, which came in 4.2% be­low its bud­get tar­get, said “we use a so­phis­ti­cated com­puter al­go­rithm and see who’s at risk for hos­pi­tal­iza­tion. Then we run that data past the pri­mary-care doc­tors and de­velop care-man­age­ment re­sources as ap­pro­pri­ate.”

His ACO also fo­cused its ef­forts on high­risk pa­tients. Nurse prac­ti­tion­ers make monthly house calls to sick, home­bound pa­tients who had emer­gency depart­ment vis­its. Less acutely ill pa­tients re­ceive phone calls or vis­its from reg­is­tered nurses, he said.

His sys­tem’s pri­mary-care physi­cian struc­ture also con­trib­uted to the ACO’s suc­cess, he said. Physi­cian lead­ers com­mu­ni­cate about care man­age­ment and use of ser­vices to doc­tors in 21 pri­mary-care groups across north­ern Mas­sachusetts, Cape Cod and sub­ur­ban Bos­ton, he said.

“It’s nec­es­sary to have a pri­mary-care struc­ture in or­der to com­mu­ni­cate with all pri­mary-care physi­cians … to un­der­stand how to con­tin­u­ally im­prove qual­ity and de­crease un­nec­es­sary uti­liza­tion,” he said.

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