Care New England Health System in Providence, R.I., has participated in value-based contracting for years with some success. But over the last 12 to 18 months, the health system has reframed how they think about “value” to serve the community better.
“The Rhode Island landscape for value-based contracting has been financially challenging, and those pressures have forced us to ask harder questions: not just how to perform under contracts, but how to create care experiences that genuinely deliver on the promise of the quadruple aim,” said Michael Wagner, MD, president and CEO, and Todd Conklin, executive vice president and CFO of the system. “As both a physician and system leader, I’ve seen first hand the barriers patients face–fragmented transitions, friction in navigating the system and the sense that they are left on their own at moments of real vulnerability. At Care New England, our ‘win’ has been putting the patient back at the center of value-driven commitment.”
The health system’s ACO, Integra, has operated for more than a decade and became the vehicle for advancing Care New England’s value-driven care model. The executive team wanted to focus less on contract compliance and more on delivering integrated, compassionate and quality care. They are making the ease of care navigation, coordination and connection the “measure of value.”
“Integra is enhancing support for primary care physicians and their teams with a busy centralized community-based interdisciplinary team dedicated to patient care,” the pair said. “Busy primary care physicians struggle to manage sick visits, new patients and the complex needs of their populations. Integra is committed to serving as extensions of these practices in patients’ homes, hospitals and skilled nursing facilities by providing additional team members.”
The ACO has made nurses, pharmacists, community health workers, and social workers available to support clinicians and reduce primary care physician burnout. The focus on value-driven care has eased patient transitions between sites of care and improved quality metrics through a team approach.
They’re not the only ones doubling down on their efforts to redesign value.
Cleveland-based University Hospitals is also committed to value-driven healthcare and in the last 18 months has seen great results. One of the most successful programs has been an innovative enhanced recovery after surgery protocol, which the system implemented across 15 hospitals and 16 service lines to reduce the length of stay from 6.1 days to 2.1 days. Supply costs per procedure dropped and the transactional net promoter score jumped from 66% to 81%.
“This approach also extends to vital preventative care,” said Paul R. Hinchey, MD, COO of University Hospitals. “Using high-touch, team-based approaches to improve screenings and self-care across our Medicare ACO populations, we’ve seen great results for our patients.”
The system’s diabetes management dramatically improved over the last four years; the rate of poorly controlled diabetes dropped from 10.45% in 2020 to 4.96% last year. High blood pressure control increased from 72.65% to 80.92% and depression screenings rate hit 91.07%. Colorectal cancer screenings improved from 73.61% to 84.88%.
“These successes are a direct result of dedicated and inspired collaborations across many different facets of our organization, with teams focused on ensuring more of our patients receive the preventative care they need,” said Dr. Hinchey. “But the gains for our patients are the best rewards.”
The UH Coordinate Care Organization, which participates in the Medicare Shared Savings Program, is led by Peter Pronovost, MD, as board chair and University Hospitals’ chief quality and clinical transformation officer. The ACO achieved favorable quality ratings and $18 million in shared savings for the 2023 performance year.
These results aren’t possible without true alignment between the system and physicians. The Valley Health System in Paramus, N.J., spent time in the last 18 months ensuring the employed medical group and independent physicians within ColigoCare, the system’s clinically integrated network, were all growing in the same direction. The physicians focused on quality improvement to achieve No. 1 in New Jersey and No. 12 nationally for the Medicare quality performance out of 453 ACOs for the 2023 performance year.
“These results translated into our strongest year ever for shared savings – nearly $11 million earned across Medicare, Medicare Advantage and commercial payer contracts in PY2023,” said Robert W. Brenner, MD, president and CEO of The Valley Health System.
Hackensack Meridian Health based in Edison, N.J., also focused on alignment within its clinically integrated network to improve upon quality and financial successes. The health system’s big wins after redesigning care delivery to become more patient-centric, efficient and effective.
“In the past 18 months, our hospital from home program expanded from a pilot to five hospitals, admitting more than 1,000 patients,” said Patrick Young, president of population health at Hackensack Meridian Health. “Meanwhile, Hackensack Meridian Health Partners, our CIN, has earned more than $20 million in shared savings due to the effective quality care our clinicians delivered this past year.”
Springfield, Ill.-based Hospital Sisters Health System saw big savings from its ACO and MSSP after making value-driven care “inherent” in the mission, according to President and CEO Damond Boatwright. They achieved $48.2 million in savings for CMS and generated $18.9 million for the ministry for 2020-23 performance years.
“Producing a savings rate of 4.58% to 6.1% to deliver care to more than 20,000 Medicaid patients is evidence that quality outcomes and savings go hand-in-hand,” said Mr. Boatright. “In addition, we have a high risk agreement with a commercial Medicaid managed care partner that awarded HSHS and our providers a six-figure shared savings payment for effectively and efficiently managing care for this vulnerable patient population.”
