Newton, Mass.-based Atrius Health, an alliance of nonprofit physician groups and a home health agency and hospice, has been working toward population health management for some time, so joining Medicare's Pioneer Accountable Care Organization Model in 2011 just made sense.
"[The model] allows us to work with patients in ways that traditional fee-for-service Medicare does not," says Emily Brower, executive director of accountable care programs for Atrius Health. "We believe it's the right way to deliver care and is a better payment model for us and for Medicare."
That belief is driving Atrius Health to remain in the Pioneer model although it did not achieve savings in its first performance year.
Financial hurdles
Out of the 32 original Pioneer ACOs, just 13 achieved enough savings to share in them with Medicare; and, due to a number of reasons, nine Pioneers dropped out of the model after one year. Atrius Health's ACO had a financial loss of 0.98 percent in its first year as a Pioneer – which is small enough that it is within the margin of error that is considered "noise." However, Atrius Health is committed to the Pioneer model for the long haul.
The population health management initiatives Atrius Health already had in place prior to becoming a Pioneer ACO contributed to the ACO's financial results, since Atrius started with lower costs for Medicare patients. "We had many care coordination activities that would touch our Medicare patients," Ms. Brower explains. "In our market, we started out with a historical cost for these patients that was lower than many other providers in the market."
The low historical costs for its Medicare patients ended up being a challenge for Atrius Health in the Pioneer model, because the model takes historical costs and trends them forward, according to Ms. Brower. "If your historical costs are lower, the budget you have to perform within in is lower," she says. With this in mind, Atrius Health sees the 0.98 percent loss as a "break even" result.
However, Atrius Health is confident in its upcoming financial performance. "We fully expect to be generating savings in 2013," says Ms. Brower.
Successful programs
Despite the less-than-stellar financial outcomes after one year, Atrius Health has instituted some wildly successful programs as a Pioneer ACO.
One area the ACO has made great strides in is the post-acute care area of the care continuum. "Our work with our home health partner to better coordinate care is showing lots of fruits," says Ms. Brower. Atrius Health integrated its newest affiliate VNA Care Network and Hospice into its ACO activities to better coordinate care, according to Ms. Brower. Additionally, Atrius Health is working with select skilled nursing facilities in the area to make sure Atrius Health knows when an ACO patient is admitted and has created a coverage plan for its clinicians to see patients in these skilled nursing facilities so the patient gets needed skilled care and goes home with a care plan in place.
In addition to changing how Atrius Health handles post-acute care transitions, the ACO also uses a team-based primary care model that has been useful for chronic disease management. With the use of CMS claims data, Atrius Health has developed rosters of high-risk patients for every primary care practice, so the team, which includes a nurse care manager, can reach out to the patient and make sure the patient has his or her care needs met. Also, in every practice, care teams meet once a week to review the roster of high-risk patients to keep their care plans current.
Future plans
Since deciding to stay in the Pioneer ACO model, Atrius Health committed to the model for two more years, with an option to extend for another two years, and Ms. Brower says Atrius Health is poised to make quality and financial gains down the road.
This year, Atrius is building alert tools for its electronic health record system to improve the capture of measures that are clinically important for the patient population. For instance, Atrius Health developed a tool to alert providers if a patient needs an annual fall risk assessment. "We're making sure we have the right tools to measure something that's clinically important and capturing it to make sure the patient receives the best care possible," says Ms. Brower.
Atrius Health has also started a program to make sure providers listen to and know patients' wishes for care at the end of their lives. "It's important for the primary care provider knows how the patient wants to be cared for at the end of [his or her] life," Ms. Brower says. So, Atrius Health has started an internal training program to ensure providers feel comfortable speaking with patients about the topic and know how to record the patient's wishes in the medical record.
Overall, Atrius Health is confident in the Pioneer ACO model's goals of improving outcomes and patient experience while lowering costs, according to Ms. Brower. "We are totally committed, and our people are very engaged in this work," she says.
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