What Makes an ACO in the Bronx One of the Top-Performing Pioneers?

Recently released analyses of Medicare's Pioneer accountable care organizations showed the program gleaned gross savings of $147 million in 2012, the first year of its operation. However, some Pioneers performed much better than others — only nine of the 23 Pioneers had significantly lower spending growth in 2012.

Even of those nine super successful organizations, one Pioneer stood out amongst its peers: Montefiore Medical Center in the Bronx, N.Y., was the most financially successful Pioneer, according to CMS, achieving $24 million in savings.

That amount was enough to net the ACO a check from CMS for $14 million in shared savings.
While it's not clear what those ACOs that shared in savings did differently from ACOs that did not, Montefiore's approach to population health management still presents some takeaways about accountable care for other providers.

Some of Montefiore's major success as a Pioneer ACO can be chalked up to programs and strategies it is implementing, whereas another portion of its success lies wholly in its years of experience in population health management.

"We've been managing populations at financial risk in models similar to the Pioneer long before 'ACO' was a defined entity of sorts," says Stephen Rosenthal, vice president of network management at Montefiore. The system has had value-based payment contracts in some form for 17 years, which is partly why it entered into the Pioneer program to begin with.

"It's an opportunity to demonstrate that experience," Mr. Rosenthal says. "We can make mistakes, learn and continuously try to improve. That's the underlying premise of the Pioneer ACOs."

Data-driven approach

In addition to experience in the model, Montefiore's cost savings and quality gains are also due to increased patient engagement, care coordination and preventative care, driven by data. The ACO used claims data to stratify patients into populations based on risk, focusing on patients who have chronic illnesses or a history of hospitalization more intensely than others.

"Over time and through experience, we've created an organized process to identify and manage the intensive care management population," Mr. Rosenthal says. "We take the data, find who has end-stage renal disease, and see what we can provide them to help better manage it," he gives as an example.

From there, the ACO has put programs in place to aid in patient engagement, like its physician home visit program, where providers make house calls to provide patients with services like lab and radiology, or even psychiatric care. "An important part of managing the Medicare population is recognizing that mental and emotional well-being can be a factor in what's driving them to not manage their illness," says Mr. Rosenthal. For that reason, Montefiore has behavioral health services embedded in its primary care network.

Keeping an eye on broader public health opportunities

In addition to addressing behavioral health, addressing social issues also plays a large role in keeping medical costs down. Montefiore provides programs for patients to help them connect with community-based resources, like Meals on Wheels or housing support, for example. "There's a host of social issues that, if addressed, can help avoid unnecessary medical expenses," Mr. Rosenthal says.

Overall, Montefiore ACO officials have enjoyed their time in the Pioneer program and are looking forward to continued collaborations with other organizations. Mr. Rosenthal notes that sharing learning experiences with other Pioneers through meetings and webinars has been especially helpful, and working with CMS and the Center for Medicare and Medicaid Innovation has been collaborative.

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