ACO outperforms peers in quality, cost of care per patient for 2017
Bellin Health Partners’ Accountable Care Organization (ACO) has achieved the highest overall quality score and the lowest cost of care per patient among all Next Generation ACOs for 2017, the Centers for Medicare and Medicaid Services (CMS) announced recently. It marks the sixth time in as many years a Bellin Health Partners ACO has been among the tops in the nation in these areas. Next Generation is the ACO Model with the highest levels of risk and reward for providers.
Figures released in December 2018 show Bellin Health Partners generated more than $6.3 million in savings to Medicare during the 2017 performance year while producing the lowest annual cost of care of all 44 Next Generation ACOs that participated in 2017. Bellin Health Partners also was tops in quality, generating a quality score of 98.36 percent. CMS evaluates 33 quality measures in the areas of patient/caregiver experience, care coordination/patient safety, preventive health and at-risk population.
“When we succeed in terms of cost and quality, it’s our patients who benefit — and that’s what is significant about these numbers,” said Dr. Saied Assef, President of Bellin Health Partners. “Every step we take to deliver the right care at the right time and eliminate unnecessary costs improves the efficiency and effectiveness of care we’re able to provide for our ACO population.”
CMS describes the Next Generation ACO Model as an initiative for ACOs that are experienced in coordinating care for populations of patients. The model allows organizations like Bellin Health Partners to assume higher levels of financial risk and reward than are available under the Pioneer Model and the Medicare Shared Savings Program. More than 9,100 individuals are part of the Bellin Health Partners Next Generation ACO.
Bellin Health Partners has worked diligently to improve cost and quality for its ACO patients while looking for ways to apply these principles to its patient population at large. Certain provisions in the Next Generation ACO framework have helped achieve these results. They include:
• Three-day Skilled Nursing Facility (SNF) Rule Waiver: Under current policy, Medicare covers care in an SNF facility only if a patient has a prior 3-day inpatient hospital stay. This new feature may allow Medicare-covered SNF services at a participating SNF without this mandatory stay.
• Post-discharge Home Visits: Bellin Health Partners ACO is expanding its post-discharge service to provide more comprehensive follow-up care at home after hospital discharge, to help with the sometimes-challenging transition between hospital and home.
• Telehealth Expansion: Telehealth services allow patients to receive some healthcare services using real-time communication between the patient and his/her primary care doctor or specialist.
Total Next Generation ACO Model savings for 2017 were more than $208 million across 44 ACOs, CMS reported. The Model runs through 2020.
Bellin Health has a history of success with ACO programs. From 2012-15 it participated in CMS’s Pioneer ACO Model through a collaboration with ThedaCare known as Bellin-ThedaCare HealthCare Partners. The partnership received national recognition for generating $14 million in savings — while simultaneously producing the highest quality and lowest cost in the country among Medicare ACOs.
“We’re pleased with our cost and quality metrics, but at the end of the day it’s about how we’re able to better coordinate care for our patients,” said Naomi Wedin, Bellin Health Partners Executive Director. “We’ve learned so much through our participation in these programs and we look forward to applying these lessons for the benefit of every patient we serve.”
Accountable Care Organizations can be comprised of groups of doctors, hospitals and other healthcare providers and suppliers who come together to provide coordinated, high-quality care at lower costs for patients. In shared savings models, targets are set for healthcare costs and quality for a defined population of patients, with an incentive for ACOs to receive a portion of savings if the amount spent is lower than the projected amount and quality benchmarks are achieved. Risk is also assumed in participation in shared savings models, with the potential to receive lesser reimbursement if costs are higher than projected or quality measures are not met.
About Bellin Health: Bellin Health, www.bellin.org, is an integrated healthcare delivery system based in Green Bay, Wis. It has served people in Northeast Wisconsin and Michigan’s Upper Peninsula since 1908. Bellin Health has more than 4,000 employees and is known for its emphasis on preventive healthcare and is a leader in cardiac, orthopedics, sports medicine, digestive health, mental health, and primary care medicine. It is comprised of Bellin Hospital, Bellin Psychiatric Center, 31 Bellin Health primary care physician clinics, and several retail health clinics known as Bellin Health FastCare. Bellin operates Bellin Health Oconto Hospital, a critical care access hospital in Oconto, Wis., Bellin Fitness, Bellin Health Home Care Equipment and Bellin College. The health system also belongs to Bellin Health Partners, a clinically integrated network that includes Bellin Health, its employed providers and independent affiliated providers; Holy Family Memorial in Manitowoc, Wis., and its employed providers; and Dickinson County Healthcare System in Iron Mountain, Mich., and its employed providers.