High-performing ACOs Demonstrate Savings, Improved Care

September 07, 2016 04:04 pm Michael Laff

Several accountable care organizations (ACOs) recorded major cost savings and improved care coordination during 2015, charting a path that federal health officials are touting as a model for primary care's future.

[Birds-eye view of doctors meeting in hallway]

By reducing hospital admissions and scoring high on patient satisfaction, the leading ACOs are rewarded with large shared savings payments, according to a recent CMS performance report(www.cms.gov) on their progress.

ACOs reported $466 million in savings during 2015, and they have saved $1.29 billion since their inception in 2012, according to CMS. Of the 392 organizations in the Medicare Shared Savings Program and the 12 in the Pioneer ACO Model with agreement start dates in 2012, 2013, 2014 or 2015, 125 reached goals to qualify for shared savings payments.

About 9 million Medicare beneficiaries currently are served by ACOs.

Several of the top-performing ACOs are in Florida, including the Palm Beach ACO, which generated more than $76 million in total savings and received $37 million in shared savings in 2015, ranking second nationally. First overall was Memorial Hermann ACO in southeast Texas, which generated $89 million in total savings and $42 million in shared savings.

Story Highlights
  • Accountable care organizations (ACOs) reported $466 million in savings during 2015, according to a recent CMS report.
  • One organization, Palm Beach ACO in Florida, generated over $76 million in total savings and received $37 million in shared savings.
  • Palm Beach ACO's chief operating officer says family physicians are the key to the organization's success.

Several smaller networks also performed well, including the Southern Kentucky Health Care Alliance, which had 16,000 beneficiaries. It earned a perfect quality score and saved $13 million. Another small ACO, the Rio Grande Valley Health Alliance in Texas, covers 5,400 beneficiaries and saved $14 million.

Knowing Patients, Tracking Data

"Family physicians are the key to our success," said David Klebonis, chief operating officer for the Palm Beach ACO. "We involve the doctors who know the patients the best while providing tools and data to help in primary care."

By next year, the network plans to launch two new tools. One is a phone system patients can call at any hour to reach a nurse who can retrieve the caller's medical records. The second is a mobile application that will update primary care physicians on patient admissions and discharges from the hospital.

"Medicare really wants these programs to work so they made program changes and listened to doctors," said Rohit Dandiya, M.D., board chair for the Palm Beach ACO. "They listened and created a reasonable benchmark. To keep going down the fee-for-service road is untenable. With ACOs, there is higher quality and less waste."

Dandiya noted that Medicare officials are well aware that the continued rate of savings will level off, but he said high-performing ACOs will still receive incentives for keeping costs down.

Palm Beach ACO studied its data closely and found that addressing hospital readmissions was one way to reduce costs. From 2014 to 2015, it reduced admission rates in one hospital from 18 percent to 10 percent after physicians began to focus on "soft" or "comfort" admissions in which a patient is hospitalized as a precaution.

"Instead of sending a patient to the hospital, tell them to come over to the office, and tell them you will wait until 6 p.m.," Dandiya said. "Don't just admit a patient to the hospital for comfort. Talk to the family and explain to them why there is no need to go to the hospital or the ER."

For patients who are hospitalized, Palm Beach physicians work with emergency medicine physicians and other subspecialists to allow those who need more care to stay another day to avoid readmission. Patients are seen in primary care within three days after they are discharged, and the network's goal is to reduce that to two days.

"There is intense collaboration between these physicians," said Arthur Hansen, D.P.M., Palm Beach ACO's physician CEO. "They communicate on specific patients to outline a treatment plan. In the past, care was fragmented. If a physician did not have a patient's records, he would do a test or do labs again. Now one physician will say to another, 'The last time you saw this patient you did this.' Physicians remember patients when they look at their old notes, and they can collaborate with each other."

Coordinating Care

To maintain continuity of care, patients with chronic conditions who leave for vacation receive full prescription refills, copies of all their relevant medical records -- including X-rays -- and contact cards so medical staff in another state can reach their primary care physician if needed.

The Palm Beach ACO continues to expand its network, which now covers 60,000 beneficiaries and includes 240 primary care physicians and 160 subspecialists.

"If physicians can create a network of 15 to 20 PCPs and key subspecialists, they should succeed" in the ACO model, Klebonis said. "One physician can't answer the phone and cover all the subspecialties all the time. You need to coordinate with other doctors and have a critical mass."

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