ACO

Part
01
of two
Part
01

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

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 website has 30,000 Medicare patients and 275 participating physicians" in Florida.

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.

Mercy

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.
Part
02
of two
Part
02

ACOs: Examples of Struggles

INTRODUCTION:

More than 335 Accountable Care Organizations (ACOs) are currently participating in the Medicare Shared Savings Program (MSSP). Most Medicare ACOs are succeeding at meeting their quality benchmarks, but only about a quarter have succeeded at reducing their spending enough below projected financial targets to qualify for shared savings. Three examples of ACOs that faced financial struggles and ultimately quit their ACO programs are Dartmouth-Hitchcock, WakeMed Key Community care & River Health.

FINDINGS:

After a thorough search, I found three examples of struggles of ACOs specifying how they have faced losses with their respective programs. I also provided a link to individual website for each ACOs. I also found information on the general struggles by ACOs. My research had a global focus, hence no country was specified as the focus.

GENERAL STRUGGLES OF MEDICARE ACO S

This website gives detailed information on the following list of general challenges ACOs are facing:
1. Make Technical Adjustments to Benchmarks and Payments.
2. Transition to More Person-Based Payments.
3. Increase Beneficiary Engagement.
4. Enhance and Improve Alignment of Performance Measures.
5. Enable Better and More Consistent Supporting Data.
6. Link to Additional Value-Based Payment Reforms.
7. Develop Bonus Payments and Other Incentives to Participate.
8. Support Clinical Transformation.

Here is a website that gives a list of ACOs and information on each with their respective websites.

FINDINGS OF PREMIER INC. SURVEY:

Premier Inc., a healthcare improvement company surveyed 68 ACOs of which 79 percent provide care to Medicare patients; 44 percent to commercially-insured patients; 35 percent to Medicare Advantage patients; 35 percent to employer-based patients and 24 percent to Medicaid patients.
Results of this survey showed that around 70 percent of ACOs were experiencing great difficulty when attempting to integrate data from specialists, especially from those out-of-network. The more care settings and providers visited by a patient, the less likely the initial provider would receive patient data from those appointments.

EXAMPLES/CASE STUDIES OF STRUGGLES FACED BY ACOs:

1. Dartmouth-Hitchcock

Website: http://www.dartmouth-hitchcock.org/about_dh/accountable-care-organizations.html

In 2012, Dartmouth-Hitchcock, joined Medicare's Pioneer ACO Model with its at-risk shared savings program. Their experience with its ACO explains how the spending benchmarks set by the model, if not properly calibrated, can backfire.

During their first year, the organization enjoyed more than $1 million in shared-savings payments while meeting quality benchmarks such as monitoring patients with chronic conditions. It covered more than 17,000 patients, spending $9,815 per patient compared with $10,501 for a national comparison group. But in 2013 and 2014, it lost $1.4 million and $3.6 million respectively.
Dartmouth-Hitchcock then dropped out of the Pioneer ACO Program. It cited unsustainable losses due to its already low-cost operating environment—not from the actual care it provided. The benchmarks of the ACO had two problems:

1. The benchmarks weren't set until the performance year finished. It seemed like they were chasing a moving target they could not see.

2. The benchmarks were relative, tied partially to the ACO's baseline spending and partially to other organizations around the country. The organizations that started off with excess utilization and spending had more room to succeed compared to those with low baseline use of healthcare services, like Dartmouth-Hitchcock.

Dr. Jim Weinstein, CEO of Dartmouth-Hitchcock said “We can't go from one of the lowest rates in the country to a rate that's even lower that denies patients care.” He called this one-size-fits-all approach to ACOs worrisome. “You can't make the system in New Hampshire the same as the system in Texas,” he said.

Dartmouth-Hitchcock joined the Next Generation program, starting Jan. 1, 2017, despite the challenges it encountered in the Pioneer model. "With Medicare's Next Generation ACO Model, the CMS has improved its systems to allow health systems to get patient benchmark data in real time and set appropriate savings targets" Weinstein said.

2. WakeMed Key Community Care

Website : http://www.wakemedkeycc.org/

WakeMed Key Community care, a joint venture between WakeMed Health and Hospitals and Key IPA faced difficult financial metrics with their ACO. Their Board of Managers decided to withdraw from the Next Generation ACO program for 2016 after discovering the loses incurred, post evaluation of financial and operational metrics.

3. River Health ACO

Website : http://www.familyhealthaco.org/about-us

The Harrisburg, Pa.- based River Health ACO, was formed in 2012 as a partnership of PinnacleHealth System, Susquehanna Health and affiliates, previously participated in Medicare Shared Savings Program. Just weeks after its selection for the Next Generation Accountable Care Organization program, it decided to leave the program since it could not meet the target of the Next gen ACOs.

"While RiverHealth ACO managed the rate of increase in costs to below the national average, projections do not indicate that the ACO would be able to meet the current target set by CMS," RiverHealth said in a statement released in February 2016.

CONCLUSION:

Most Medicare ACOs are succeeding at meeting their quality benchmarks, but only about a quarter have succeeded at reducing their spending enough below projected financial targets to qualify for shared savings. This is resulting in loss of millions for some ACOs, resulting in them quitting their programs. Three such examples of ACOs are Dartmouth-Hitchcock, WakeMed Key Community care & River Health.
Note: I observed that the general examples on the struggles of ACOs were in line with the Next Generation ACO program. Most of the ACOs could not meet the financial target set by their program. Therefore, I suggest that the client send a follow up request, to find more information about the Next Generation ACO program.
Sources
Sources