Expanding Our Reach Through Accountable Care

by Purity Nyaga, MSN, RN
Clinical Director, Accountable Care Organization (MPCACO), Methodist Health System
In 2012, Methodist Health System waded into the new world of accountable care by being selected as a participant in the Centers for Medicare and Medicaid Services (CMS) Accountable Care Organization (ACO) Medicare Shared Savings Program (MSSP). The ACO model was designed to provide beneficiaries with high-quality service and care while reducing overall expenditures by enhancing care coordination. To assure the achievement of this triple aim, CMS established 33 quality measures relating to care coordination and patient safety, identified appropriate use of preventive health services, improved care for at-risk populations, and enhanced the patient and caregiver experience of care.

Methodist was a pioneer in this care delivery arrangement. We applied for the MSSP and were accepted into the pilot program as the first ACO in North Texas. What’s more, we were the only ACO in the area to achieve cost savings

As an early adopter, Methodist Patient-Centered ACO (MPCACO) focused on doing everything we could to reduce costs, improve quality, and increase patient satisfaction. There were a lot of opportunities to serve our beneficiaries with needs that included transportation, food, finding doctors and equipment, and so on. We saw lives changed and made a lot of friends in the process. Above all, we were able to positively affect a significant number of beneficiaries’ lives, which in turn resulted in lower readmission rates, reduced unnecessary emergency room visits, and decreased avoidable hospitalizations. When CMS announced the first-year results, we were amazed — $12.7 million in savings!  We were off to a great start.

You may be wondering why Methodist leadership decided to pursue this new venture. Our leadership was looking for innovative ways to fulfill our mission and vision. They were assertive and wanted us to be part of the solution to the health care challenges that face the entire industry.

Since 2012, we have seen the broad range of benefits that an ACO offers to patients, providers, and the community as a whole. Besides the cost savings, we have been able to document improvement in the quality of care for the beneficiaries covered by our organization. Our navigators have seen more than 3,000 patients. Even more important, we’ve seen individual lives impacted and changed for the better.

Coordinated care is the key to the ACO’s success. Our care navigation department is staffed with registered nurses, clinical social workers, community health workers, health coaches, and other health care professionals who are ready to go into the community and into beneficiaries’ homes to work with them according to their needs. The ACO staff also helps beneficiaries coordinate care with specialists, communicate with pharmacies, set up appointments for patients, arrange for home visits, assist with community resources, coordinate finding the appropriate post-acute-care providers, provide health care education and coaching, and much more.

We have been able to build the ACO from the ground up, including forming strategic community partnerships. One example is our partnership with the North Texas Food Bank, which helps us provide fresh fruits and vegetables to eligible beneficiaries. In fact, approximately 8,000 pounds of fruits and vegetables are distributed monthly. We also provide transportation cab vouchers to beneficiaries so they can get to their treatment and follow-up visits with their physicians. We refer our beneficiaries to area agencies for services, including:

  • CitySquare — providing multiple services at reduced rates, like housing, food pantry, and legal
  • Adult Protective Services — a safety support system for patients who need it
  • Metrocare — mental health and developmental disabilities support
  • American Cancer Society — a comprehensive program with a 360-degree assessment of medication and financial support needs for patients and their families.

Based on our patients’ needs, we continue to pursue new strategic partnerships and collaborations.

What are some of the key takeaways we’ve learned over the past three years? They include:

  1. Realizating that the health care system is much more fragmented than we originally thought
  2. Learning that care incentives for doing the right thing under the traditional fee-for-service model are misaligned and contribute to many of the problems addressed by accountable care
  3. Appreciating that this effort is going to require a lot of work in order for all of us to continue to move forward.

The next two to three years will be an exciting time for the MPCACO. We anticipate significant growth in total number of lives covered, from our current number of 25,000 to around 100,000. We also look forward to networking and sharing with other participating organizations in the CMS ACO program, as well as commercial ACO programs within our region.

The ACO is still an unfamiliar concept to many in health care. From the beginning of the ACO movement, Methodist has taken a leading role to move from volume-based care to care that is value based. As an organization that cares for the well-being of its employees, the MPCACO will begin assisting in managing the health of employees and their dependents by offering navigation services, health coaching, weight-loss and smoking-cessation programs, and any other services that they may need to promote health and wellness. This is another example of Methodist’s commitment to the health and well-being of our family members. As a caregiver, isn’t this the type of organization where you want to work and grow?

If you’re ready to join an innovative leader in health care delivery, consider Methodist Health System. To learn more, visit us at Jobs.MethodistHealthSytem.org.

© Methodist Health System
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