Category: 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:
- Realizating that the health care system is much more fragmented than we originally thought
- 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
- 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
By Shannon Huggins
Vice President, Managed Care
Methodist Health System
Sometimes, the ABCs of health care can be confusing. But in the new world of health care reform, there’s one acronym that everyone needs to know — ACO. ACO stands for accountable care organization. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is a group of doctors, hospitals, and other health care providers who work together to provide patients with better, more coordinated care. The providers who participate in an ACO — hospitals, physicians, and post acute-care organizations — generally care for a patient population of at least 5,000 lives, thus the growing interest in population health management.
Theoretically, an ACO turns the health care system on its head by changing the focus from pay-for-volume (fee-for-service medicine) to pay-for-performance (outcomes-based medicine). Improved health should result from collaboration, coordination, and information-sharing among all providers involved in each patient’s entire episode of care.
Why has this new payment model emerged as the primary vehicle for future health care delivery? One word comes to mind — money. The fact is, the current model is a significant contributor to the nation’s debt worries, with some experts forecasting that the Medicare Trust Fund will exhaust its financial resources within a few years.
On July 1, 2012, the Methodist Patient-Centered Accountable Care Organization (MPCACO) was selected to participate as an accountable care organization in the Medicare Shared Savings Program, a multifaceted new program sponsored by CMS. More than 200 physicians are partnering in the MPCACO.
Through the Shared Savings Program, MPCACO is working with CMS to provide traditional Medicare beneficiaries with enhanced care coordination designed to provide them the right care, at the right time, and in the right setting. It’s a proactive model, rewarding the hospital when a beneficiary can avoid a visit to the emergency room or hospital. And, with 13,000 people in the ACO, it’s no small feat!
Changing the patient experience will require delivering care in new, innovative ways. Error-free handoffs and transitions accomplished via improved communication are at the heart of the new care delivery model. For inpatient nurses, that’s important because he or she will now know that when patients leave their care in the hospital, they will continue to receive needed care throughout the year.
Providers participating in ACOs are approaching them in different ways, depending on where they started the journey. ACOs will shine the light on the serious problem of shortages of health care professionals, especially with nurses, case managers, and social workers. Caregivers will have more information on their patients before they come to the hospital, enabling caregivers to engage at a higher level and create more cost-effective, seamless care.
MPCACO is physician-led, and Methodist is assisting MPCACO in its efforts to provide those physicians with tools to better coordinate the work that they do. MPCACO has engaged Methodist to hire support staff, including care navigators and social workers. And MPCACO, with Methodist’s help, is analyzing our data and the data from CMS to produce predictive models that will help maximize resources.
If you’re ready to improve the care that you provide to patients with an organization that’s participating in the future of health care today, then it’s time to choose Methodist Health System. Learn more by visiting Jobs.MethodistHealthSystem.org.
© Methodist Health System