While ACO Care Coordination Holds Promise for Improving Quality and Lowering Healthcare Costs, It’s Still a ‘Work in Progress’
Healthcare Experts Now Exploring New Care Coordination Strategies and Overcoming Gaps in Measuring Performance
For many healthcare professionals, the jury is still out as to whether accountable care organizations (ACOs) will prove effective at delivering the two important goals of improved patient outcomes at a lower overall cost of care over an extended period of time.
That is why close attention is being given to the experience of Medicare’s Pioneer ACOs, since they were among the first ACOs to begin delivering clinical services. In particular, physicians and hospital administrators want to learn useful lessons from the successes and setbacks of the different Pioneer ACOs.
By improving the coordination of care, accountable care organizations are expected to provide patients with better care while reducing healthcare costs. That’s why the Center for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program is structured to pay ACOs financial incentives or impose penalties, depending on whether performance quality measures and healthcare spending targets are met.
Care Management: ‘A Work in Progress’
CMS saw a number of ACOs exit the program in the second year, after the one-year exemption from financial risk ended. The reason is care management is still “a work in progress,” noted a report published by Modern Healthcare that was based on the findings of its annual ACO Survey. ACOs are still experimenting with care coordination and patient management strategies and how to measure their impact.
Of the 37 ACOs responding to this year’s Modern Healthcare survey, roughly one-third have contracts that include the risk of financial loss if the ACO fails to meet spending and quality targets.
“This [care management] is a very nascent science,” suggested Namita Mohta, M.D., Medical Director for Boston-based Partners HealthCare’s Department of Population Health Management. “But we have a lot to learn about how to improve care coordination overall for our patients as well as how to measure it effectively, so then we can improve our performance.” She explained that efforts to improve the performance of an ACO involve “a relentless focus on coordination of care and reduced fragmentation.”
This year’s Modern Healthcare ACO Survey added two questions about care coordination: Is care coordination managed? If so, what are the top five measures used? The most-reported measure by the 37 respondents was the rate of hospital readmissions. The participating ACOs ranged in size from 5,600 to 553,000 patients.
Partners Health ACO Tracks Hospital Readmissions
Rather than measure care coordination efforts, the Partners Healthcare ACO, for example, measures results by tracking hospital readmissions and the quality of care provided to medically complex and terminally ill patients.
Heartland Regional Medical Center in St. Joseph, Missouri, also tracks the percentage of patients who rank among the most costly. These are the patients with costs in the top 5%, and they receive screenings from care managers who typically are registered nurses with care coordination experience.
Heartland also monitors patients who enter a nursing home after leaving the hospital. This includes a care manager visit to the nursing home within 48 hours after the patient’s discharge to discuss treatment and medications with the facility’s nurses, noted Linda Bahrke, R.N., Administrator of Heartland’s Community Health Improvement Plan. This strategy has proven so effective Heartland is considering expanding it to all Medicare patients. “We anticipated there would be value, but there was more than we realized,” she said.
Overall, Heartland estimates that care-coordination efforts for the 5% most costly ACO Medicare patients resulted in 0.93% savings per month, per patient. Therefore, Heartland now plans to expand its coordination efforts to the top 15% most expensive patients.
“We plan to engage with those people sooner,” Bahrke added, noting that Heartland will continue to track monthly expenses over time for the top 5% to determine if earlier intervention can further reduce total costs, noted the Modern Healthcare article.
—By Patricia Kirk