ACOs: Successful Examples
Four case studies of successful Accountable Care Organizations (ACOs) are presented below, along with brief details on what comprises that ACO and how they quantify success. They are UnityPoint Health, Memorial Hermann Healthcare System, Palm Beach, and Mercy.
UnityPoint Health is a $4B health system with 43 hospitals located in the states of Iowa, Illinois, Wisconsin, and Missouri. It has just under 100,000 Medicare beneficiaries and contracts with private payers, such as, United Healthcare and Blue Cross and Blue Shield of Illinois. With its self-insured health plan it encompasses another 130,000 patients.
Its notable areas of success are tracking high-risk patients, using its monitoring systems to see patterns in patient's health data, and in reducing unnecessary costs. These measures have enabled UnityPoint Health to save roughly $24 million in expenses since its inception. One way these efforts have improved patient services is in using data to predict which diabetic patients are likely to be hospitalized in the next six months and then developing preventive care and outreach efforts with these patients. Another example is by reducing unnecessarily long stays in nursing facilities by using software to monitor how long each patient should ideally remain. This is necessary as these facilities often have financial incentives to keep these patients longer.
Memorial hermann healthcare system
Memorial Hermann Healthcare System (MHHS) has 11 acute care hospitals and 3,600 beds in the Houston metro area and leads the state with a market share of 25%. Its ACO, MHACO website was launched as a pilot, exploratory initiative. It was led by executives that administered MHMD and was based on preparation already underway to practice population health under a fixed payment system.
MHACO utilized similar techniques to Unitypoint above, focusing on high-risks patience, developing digital systems to coordinate and eliminate redundancies, as well as control chronic conditions. These efforts led to savings of over $53 million in the years 2013-2014.
One specific area of focus for MHACO was a shift from the convenience of the doctor to the convenience of the patient. This included efforts like access to a physician at any time, day or night, same day or next day appointments, and having health care 'teams,' where social workers, nurses, and community care individuals all worked closely with doctors and patients. This total care led to prevention of repeat visits and long-term savings.
palm beach aco
Palm Beach ACO, developed with an external partner (Salient Management Company) a system to track patients and encourage them to come in for wellness and preventative visits. This helped to save the Medicare system 62 million dollars in 2016.
In addition, they took a different tack to promote patient well-being. This effort focused on "fostering competition among its own members, [with] those that had the best results were highlighted to the staff and patients. This approach, along with rewarding doctors who had full knowledge of their patient's background, helped ensure quality client care.
The Mercy ACO website has more than 2,300 doctors and 500 practice sites organized into regional ACOs and clinically integrated networks in and around Des Moines, Iowa.
The Mercy ACO uses similar methods to the other successful ACOs above: a sophisticated data and patient tracking system which lets them monitor clients and contact them for wellness and prevention appointments; a drive to provide the patient choices and convenience; and a focus on high risk and repeat patients. These efforts have led the ACO to save over $65 million in five years.
One unique area that Mercy has explored and promote on its website is its healthcare coaches. These are specific experts hired to work with individual patients in primary physicians offices. These coaches work closely with patients, creating tailored programs and plans for each client. In one area, patients trying to reduce high blood pressure, 74% percent of patients were successful with help from a coach, far better than the national average.
Conclusion and areas for further research
In examining these case studies, three common variables or actions that have led to these ACOs being successful appear.
The first of these is a strong patient data tracking system. All four of these ACOs have one in place, which allows them to monitor their patients, keeping track of many different data points, and managing risk. They also provided alerts and ways to inform patients of important preventive health actions, like regular checkups. Without this backbone, all the ACOs above would likely not have been nearly as successful.
A second, related commonality is an intense monitoring of high risk, repeat patients, and finding ways to reduce their re-admission rate into hospitals, usually through healthy living and wellness appointments with local physicians. In all of these success stores, the ACOs used their data monitoring system to keep track of these patients. This allows them to usually provide cheaper, more effective options over repeated hospital visits, such as the health coaches mentioned above.
Speaking of health coaches, the third common element of success seems to be some kind of personal outreach to patients and focusing on their general wellness, not just the narrow treatment of specific ailments. Each of these ACO's offer patients wide choices of doctors, as well as unique offerings such as anytime access to doctors or competition for best services among staff to clients. They also integrate lifestyle and community health officials into the overall health of the patient. This, in turn, reduces expensive hospital visits and ultimate saves both the Health Systems and Medicare money.
Each of these areas will hopefully provide ideas for future research and investigation into successful ACOs.