Value-Based Care News

Small Steps for Accountable Care Organizations to Boost Quality

In order to cut down on expensive emergency room visits, Coastal Medical keeps its doors open 365 days a year. Additionally, patients can visit the primary care office until 9:00 PM on weeknights.

By Vera Gruessner

- While the Medicare Shared Savings Program and the Pioneer Accountable Care Organizations (ACOs) are relatively new programs for the Centers for Medicare & Medicaid Services (CMS), various results show that these models of care have not brought in favorable results or significant cost savings.

Medicare Shared Savings Program

According to the Health Affairs publication, only 22 percent of ACOs participating in the Medicare Shared Savings Program were able to participate in shared savings payments by cutting down on their healthcare spending.

Earned savings and healthcare quality

Additionally, one major issue that may harm the further expansion of Accountable Care Organizations is the potential lack of correlation between quality of care and earned savings. For example, one analysis shows that in Performance Year 1, earned savings correlated with healthcare quality at only 8.6 percent.

While the first year did not have as many consequences, ACOs that perform poorly on quality benchmarks in future years will likely lose out on some shared savings from their payer or, in this case, CMS. After reporting quality measures, it was found that ACOs scored anywhere from the 30th to the 90th percentile.

Such a large discrepancy in healthcare quality shows that it may take more time for these models of care to truly boost their performance and meet cost reduction goals. Despite this fact, the popularity of Accountable Care Organizations and value-based care payment models continues to grow around the nation.

The US News & World Report mentioned that population health management and ACO development has been strong in 2015. This past year, there has been more focus on disease prevention and keeping patients out of the hospital. Along with Accountable Care Organizations, bundled payment systems and value-based reimbursement has forced providers and payers to address population health.

“A small team takes care of these families,” Chris Trimble from Dartmouth's Tuck School of Business and the author of How Physicians Can Fix Health Care: One innovation at a Time told the news source.

“There's no technology, no rocket science, nothing complicated going on here. Just extra care, carefully coordinated. They deliver a fantastic result, simultaneously improving outcomes and reducing costs.”

Payers address value-based care

Ray Desrochers, Chief Marketing Officer of HealthEdge, spoke to HealthPayerIntelligence.com about the health payer market’s move toward value-based reimbursement and support of new models of care like ACOs. While many payers are looking to adopt new systems of provider reimbursement, there are significant challenges that are standing in the way of the health insurance industry, Desrochers explains.

“What’s happened here is we have built over many years a decent infrastructure that is really focused on servicing this one-size-fits-all version of healthcare particularly these fee-for-service models,” Desrochers began.

“As we start to move into things that are much more individualized, personalized, and customized – that’s both on the benefits and payments side leveraging value-based care benefits and payments as well as the new ACO models and individual market models – we are suddenly in a world where the one-size-fits-all approach doesn’t work anymore.”

“People are seeing that there’s a fundamental disconnect in terms of the technology that’s in the organizations today, which was great in the old days but was never built or designed to handle any of the things we’ve just talked about.”

“They’re also seeing a fundamental disconnect with their people and processes. What many of these organizations are doing is they’re undertaking a fundamental transformation of the business. Most of the executives now believe that this transformation of their businesses is the only way they’re going to compete in this new healthcare economy.”

Coastal Medical

The Boston Globe reported on the benefits of altered payment models and implementation of Accountable Care Organizations. In one example, a patient named Louis Verdelotti was diagnosed with diabetes and needed to learn how to perform insulin injections on himself.

His primary care doctor referred him to Susan Plante, a pharmacist from Goldfarb’s group, Coastal Medical, which is an important action on the part of the Accountable Care Organization that serves Verdelotti.

ACOs are formed when primary care doctors, specialists, hospitals, and payers come together to manage the health of a group of patients with a focus on disease prevention and wellness. When working through the Medicare Shared Savings Program, ACOs that meet quality metrics and lower costs of care are able to take part in the shared earnings.

Coastal Medical is one Accountable Care Organization that has met performance quality metrics and saved $7.2 million in 2014 despite the fact that other ACOs fell short of these achievements.

“You’re making yourself accountable for the care of a population — not just the people who are in front of you, but even the people who might not have scheduled a visit all year with you,” Dr. G. Alan Kurose, Coastal’s President, told the news source.

There are certain measures that this particular ACO has taken to reduce costs and improve access to care. For instance, in order to cut down on expensive emergency room visits, Coastal Medical keeps its doors open 365 days a year. Additionally, patients can visit the primary care office until 9:00 PM on weeknights.

One other way to provide better care and ensure patients’ concerns are addressed that Coastal Medical has adopted is the provision of nurse care managers to help discharged individuals transition to the home setting or a rehabilitation center.

Data shows that this particular ACO ranked the highest among the 19 models implemented throughout the state of Massachusetts. In order to meet quality performance metrics and work toward reducing the cost of care, Accountable Care Organizations around the country could take some lessons from Coastal Medical as a means to earn shared savings.