Archive for the ‘Post-Acute Care’ Category

Infographic: Top 5 Strategies for Managing Post-Acute Care

April 14th, 2017 by Melanie Matthews

As post-acute care costs increase, now accounting for $1 out of every $4 spent by Medicare Advantage plans, health plans are focusing on post-acute care management, according to a new infographic by CareCentrix.

The infographic examines the top five strategies healthcare organizations are using to manage post-acute care.

Medicare's proposed payment rates and quality programs for skilled nursing facilities (SNFs) for 2017 and beyond solidify post-acute care's (PAC) partnership in the transformation of healthcare delivery. Subsequent to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), forward-thinking PAC organizations realized the need to rethink patient care—not just in their own facilities but as patients move from hospital to SNF, home health or rehabilitation facility.

Post-Acute Care Trends: Cross-Setting Collaborations to Align Clinical Standards and Provider Demands examines a collaboration between the first URAC-accredited clinically integrated network in the country and one of its partnering PAC providers to map out and enhance a patient's journey through the network continuum—drilling down to improve the quality of the transition from acute to post-acute care.

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How a Data Dive Makes a Difference in ACO Care Coordination Efficiency

March 30th, 2017 by Patricia Donovan

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UTSACN used data analytics to trim its home health network from more than 1,200 agencies to 20 highly efficient home health providers.

How does UT Southwestern Accountable Care Network (UTSACN) use information to inform and advance care coordination programming? As UT Southwestern's Director of Care Coordination Cathy Bryan explains, a closer look at doctors' attitudes toward a Medicare home health form initiated a retooling of the ACO's home health approach.

We realized our home health spend was two times the national average. When we reviewed just the prior 12 months, we identified more than 1,200 unique agencies that serviced at least one of our patients. With this huge number of disparate home health agencies, it was difficult to get a handle on the problem.

Our primary care doctors told us they found the CMS 485 Home Health Certification and Plan of Care form to be too long. The font on the form is four-point type; it's complex, so they don't understand it. However, because they don't want a family member or patient to call them because they took away their home care, they often sign the form without worrying about it.

As we began looking at these findings, we wondered what they really told us. Are some agencies better than others, and how do we begin to create a narrow network or preferred network for home care? We knew we couldn't work with 1,200 agencies efficiently; even 20 agencies is a lot to work with.

We began to analyze the claims. My skilled analyst created an internal efficiency score. She risk-adjusted various pieces of data, like average length of stay. For home health, there were a number of consecutive recertifications. We looked at average spend per recertification, and the number of patients they had on each agency. We risk-adjusted this data, because some agencies may actually get sicker patients because they have higher skill sets within their nursing staff.

We created a risk-adjusted efficiency score based on claims. We narrowed down the list by only looking at agencies with 80 percent or higher efficiency. That left us with about 80 agencies; we then narrowed our search to 90 percent efficiency and above, and still had 44. That was still too many, so we cross-walked these with CMS Star ratings to narrow it even more. Finally, after looking at our geographic distribution for agencies that serviced at least 20 patients, we eliminated those with one and two patients. We sought agencies that had some population moving through them.

Ultimately, we reduced our final home health network to about 20 agencies that were not creating a lot of additional spend, and not holding patients on service for an incredibly long period of time.

Source: Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives

advanced care coordination

During Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives, a 2016 webinar available for replay, Cathy Bryan, director, care coordination at UT Southwestern, shares how her organization’s care coordination model manages utilization while achieving its mission of bridging the gap from where patients are to where they need to be to adhere to their care plan.

2016 Healthcare Headlines: MACRA Monopolizes News Until Election Shake-Up

December 26th, 2016 by Patricia Donovan
top 2016 news stories

The unexpected election of Donald J. Trump to the U.S. presidency threatened some healthcare initiatives from the Obama administration, including the Affordable Care Act.

There was only one thing capable of distracting the healthcare industry in 2016 from MACRA's imminent rollout: the election of Donald J. Trump to the presidency of the United States.

Nevertheless, the majority of the last twelve months was spent on healthcare business as usual—the business of transitioning to value-based models of care delivery and reimbursement.

Here are the headlines that dominated the news feeds of healthcare executives in 2016:

New CMS 'Accountable Health Communities' Model Aims to Improve Patients' Health by Addressing Social Needs

January 2016: In a first-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs, the HHS appropriated $157 million in funding to bridge clinical care with social services.

The new pilot will test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

Medicare Shares 6 Core Principles for 21 New 'Next Generation ACOs'

January 2016: The Centers for Medicare & Medicaid Services (CMS) made waves when it launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model.

Providers Slow to Adopt Population Health, Value-Based Models of Care: Study

February 2016: Most healthcare providers continue to lag in implementing population health management despite broad agreement it will be important for future market success, according to a national study by healthcare strategy consultancy Numerof & Associates. The study synthesized survey responses from more than 300 executives and in-depth interviews with over 100 key decision-makers across U.S. healthcare delivery organizations. It provided the first in-depth, national look at the pace of transition from fee-for-service to models based on fixed payments linked to outcomes.

Horizon BCBSNJ 'Episodes of Care' Program Pays $3 Million in Shared Savings to Specialty Medical Practice

February 2016: Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative Episodes of Care (EOC) Program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. The EOC model, also known as bundled payments, is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event—such as a joint replacement or pregnancy.

Bundled Payments Improve Care for Medicare Joint Replacement Patients: NYU Langone Study

March 2016: Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone Medical Center. The three-year pilot at the medical center reported reductions in patient length-of-stay and readmission rates.

CMS to Test New SNF Payment Model to Curb Readmissions, Foster Multidisciplinary Care

March 2016: The Centers for Medicare & Medicaid Services (CMS) today announced it would test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents. This next phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents seeks to reduce avoidable hospitalizations among beneficiaries eligible for Medicare and/or Medicaid by providing new payments to practitioners for engagement in multidisciplinary care planning activities.

Proposed MACRA Rule Would Streamline Medicare Value-Based Payment Models

May 2016: In issuing a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians, the Department of Health & Human Services took the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 2016: As they digested the HHS's momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations began assembling arsenals of educational tools to de-mystify MACRA. The federal government's first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

CMS Releases MACRA Final Rule; Creates Two Pathways for Clinician Value-Based Payments

October 2016: The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the healthcare system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 2016: If U.S. President-elect Donald J. Trump delivers on his campaign promises, the 'repeal and replacement' of the Affordable Care Act (ACA) should be an early priority for the nation's chief executive-in-waiting. That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts, Determine ACA Fate

November 2016: Calling his nominees "the dream team that will transform our healthcare system for the benefit of all Americans," President-elect Donald J. Trump announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

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Infographic: Optimizing Post-Acute Care

October 17th, 2016 by Melanie Matthews

Seventy-five percent of hospital readmissions are preventable—more than $17 billion annually is wasted due to readmissions within 30 days, according to a new infographic by CareCentrix.

The infographic lists four keys to success in improving post-acute care and reducing readmissions.

Medicare's proposed payment rates and quality programs for skilled nursing facilities (SNFs) for 2017 and beyond solidify post-acute care's (PAC) partnership in the transformation of healthcare delivery. Subsequent to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), forward-thinking PAC organizations realized the need to rethink patient care—not just in their own facilities but as patients move from hospital to SNF, home health or rehabilitation facility.

Post-Acute Care Trends: Cross-Setting Collaborations to Align Clinical Standards and Provider Demands examines a collaboration between the first URAC-accredited clinically integrated network in the country and one of its partnering PAC providers to map out and enhance a patient's journey through the network continuum—drilling down to improve the quality of the transition from acute to post-acute care.

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Have an infographic you'd like featured on our site? Click here for submission guidelines.

Horizon Episodes of Care Program Prototype for Value-Based Specialty Care and Reimbursement

April 21st, 2016 by Patricia Donovan

Horizon BCBS-NJ's Episodes of Care program engages specialists across a suite of nine episodes.

Imagine a value-based healthcare payment model in which the sole financial hazard to specialist providers is the risk of amassing additional revenue.

Further, envision a scenario in which these specialists are invited to design their payment program, from the model's intent to key quality metrics.

Those are some highlights of Horizon Blue Cross Blue Shield of New Jersey's Episodes of Care (EOC) program, a value-based model designed to focus specialists on the provision of quality- and value-based care across nine separate episodes, from joint replacement to hysterectomy to oncology.

Hailed as a national leader in advancing the episodes model as a prototype for value-based specialty care, Horizon is careful to distinguish its EOC program from a bundled payment initiative, for two key reasons.

"First, our EOC program is a quality-based program; it's not only about the payment or payment structure," explained Lili Brillstein, director of the Horizon Episodes of Care program during a recent webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship.

Secondly, bundled payments typically refer to a prospective model in which a bundled amount of money is paid to a provider or group of providers in advance of services being delivered, while Horizon's retrospective model pays providers after services have been provided.

The upside-only nature of Horizon's retrospective model contributes to the program's collaborative nature, Ms. Brillstein added. "If the metrics are met, savings are shared. If the metrics are not met, we’re not punishing our partners."

There is other evidence of collaboration and of Horizon's desire to see the providers succeed in the EOC program. One example is the payor's use of case mix-adjusted budgets at the practice level rather than the prevalent member-specific risk-adjusted budgets. "This budgeting allows Horizon to create an opportunity for providers to move the needle [on a metric], and benefit from that. The opportunity for cost savings and shared savings also is dramatically improved."

Another case in point is Horizon's invitation to prospective providers to talk through the episode's construct, intent and design prior to its launch.

Horizon's engagement of providers in the EOC program has "changed the spirit of the relationships between the payor and the provider," Ms. Brillstein noted. "It’s like nothing I’ve ever seen before. Our provider partners have become our ambassadors for the program."

Select EOC results presented during the webinar indicated that outcomes are better for EOC partners—in the area of reduced readmissions, for example—than they are for physicians not in the EOC program.

Horizon expects to launch at least three more episodes in 2016, including a Crohn’s Disease episode that will take into account behavioral health services for those members. While the payor fully expects to move to a prospective model, it believes its current EOC model is preparing them for that eventuality, softening the transition from fee for service to prospective payments.

"[That transition] doesn’t just happen. You don’t sign the paper, and suddenly know what to do. It is an evolutionary transformative process," concluded Ms. Brillstein.

Click here to listen to an interview with Lili Brillstein: Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

HINfographic: 2015 Post-Acute Care Challenge: How to Foster Warm Handoffs

September 16th, 2015 by Melanie Matthews

With patient transitions between care sites a top post-acute care (PAC) challenge for 25 percent of healthcare organizations, discharge planning, hiring of care transition navigators and data exchange are helping to facilitate 'warm handoffs'—full-circle communication between hospital and post-acute care clinicians regarding a patient's care—according to 2015 Healthcare Intelligence Network metrics.

A new infographic by HIN examines the top strategies to improve post-acute care and reduce costs and the percentage of healthcare organizations that include post-acute care in value-based reimbursement methodologies.

2015 Healthcare Benchmarks: Post-Acute Care TrendsHealthcare is exploring new post-acute care (PAC) delivery and payment models to support high-quality, coordinated and cost-effective care across the continuum—a direction that ultimately will hold PAC organizations more accountable for the care they provide. For example: two of four CMS Bundled Payments for Care Improvement (BPCI) models include PAC services; and beginning in 2018, skilled nursing facilities (SNFs) will be subject to Medicare readmissions penalties.

2015 Healthcare Benchmarks: Post-Acute Care Trends captures efforts by 92 healthcare organizations to enhance care coordination for individuals receiving post-acute services following a hospitalization—initiatives like the creation of a preferred PAC network or collaborative. Click here for more information.

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5 Reasons for Post-Acute Care to Participate in Bundled Payments

September 1st, 2015 by Patricia Donovan

Bundled payment participation put Brooks Rehabilitation on the forefront of healthcare payment reform.


Having completed more than 1,000 bundled episodes for total hip replacements, total knee replacements and hip fractures, Brooks Rehabilitation has achieved significant savings through Model 3 of the CMS Bundled Payments for Care Improvement (BPCI) Model 3. Here, Debbie Reber, MHS, OTR, vice president of clinical services for Brooks Rehabilitation, explains Brooks' rationale for participating in episode-based payment models.

Why would post-acute care be responsible for bundled payments, as opposed to the acute care provider? When CMS's original bundles came out, it looked as though they would all be driven by acute care providers. At the time that Brooks jumped in, there was not a lot of information on what our opportunity would be or how this model was going to look. To explain our rationale for jumping into bundled payments, Brooks decided it was going to participate in order to be on the forefront of learning more about payment reform. We wanted to look at how post-acute care providers could help make some of the healthcare policy changes related to the future of healthcare reimbursement.

Second, we also really wanted to serve as a catalyst for a business to begin working better as a system of care. With all of our different divisions and the way our care settings are spread over the various counties that we serve, sometimes it was difficult for us to work as a united, seamless system. We thought moving to bundled payments offered a great opportunity for us to work better as a system of care, improve our care transitions, and improve our continuum.

Third, the other huge opportunity with bundled payment is the chance to experiment with clinical redesign. We approached bundled payments as having a blank slate: we could redesign the care to look and feel however we wanted it to be. If we could do things all over again, what were the tasks or gaps or cracks in our clinical care that we could really improve upon?

Fourth, we knew we wanted to have a strong voice regarding future policy and payment reform changes. And finally, we wanted to show that, in addition to key providers, Brooks was sophisticated enough to take risk and play a primary role with that continuum of care.

Source: Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign

post-acute care bundled payments

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign shares the inside details of Brooks' Complete Care program and the resulting, significant savings Brooks achieved through CMS's BPCI Model 3, which is limited to retrospective post-acute care (PAC) for select diagnosis-related groups (DRGs).

Post-Acute Care Improvement: 9 Trends to Know

August 25th, 2015 by Patricia Donovan

post-acute care trends

Healthcare favors a unified cross-setting PAC payment system, according to 2015 PAC metrics from the Healthcare Intelligence Network.


Across the continuum of post-acute care (PAC) providers—defined as skilled nursing facilities (SNFs), home health agencies (HHAs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs)—skilled nursing is the sector most in need of reform, say 40 percent of healthcare organizations who responded to a 2015 survey on Post-Acute Care Trends.

Also in need of revamping are PAC payment models, the Healthcare Intelligence Network survey determined. While 53 percent have already incorporated PAC services into value-based reimbursement methodologies such as an accountable care organization (ACO) or shared savings arrangement, 60 percent of respondents would like to see Medicare adopt a unified cross-setting PAC payment system that would follow the patient across care sites.

Already participating in Models 2 and 3 of CMS’s ongoing Bundled Payments for Care Improvement (BPCI) initiative, PAC providers are also gearing up for closer scrutiny of skilled nursing facility (SNF) readmission rates by Medicare beginning in 2018. The federal payor has been monitoring 30-day hospital readmission rates since 2012, gradually expanding the list of applicable readmissions measures and scaling readmission reimbursement.

The top tactics to improve quality, enhance care coordination and reduce spend associated with post-acute care include care transition management, development of PAC partnerships and integration of all PAC services, say respondents.

Here are five more metrics from HIN's 2015 Post-Acute Care Trends survey:

  • A case manager helms PAC improvement initiatives for 38 percent of respondents.
  • Patient transitions between care sites is the top PAC challenge, say 25 percent of respondents.
  • Half of responding organizations say heart failure and shock are the most challenging health conditions to manage in PAC settings.
  • Eighty-five percent of respondents said care coordination improved as a result of these efforts, while 36 percent observed a decline in hospital readmissions from PAC facilities.
  • The INTERACT™ (Interventions to Reduce Acute-Care Transfers) program and tools, designed to reduce the frequency of PAC transfers to acute hospitals, are frequently cited by respondents as critical to PAC coordination. The INTERACT tool was initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP, at the Georgia Medical Care Foundation.

The post-acute care arena is rich with opportunity for improvement, agreed many respondents.

"PAC is the blockbuster drug the U.S. healthcare system has been waiting for," concluded one survey respondent, noting that post-acute care provides big financial levers for provider organizations to align clinically, financially and operationally. "Forward-thinking providers are organizing to amass large pools of manageable risk and recalibrating to optimize care delivery and share meaningfully in the medical expense reduction associated with better more effective and patient centric care. This is a win all the way around."

Download an executive summary of 2015 PAC survey results.

Post-Acute Care Payment Bundles: Catalyst for Clinical Redesign, Improved Care Transitions

July 30th, 2015 by Melanie Matthews

Brooks Rehabilitation jumped at the opportunity to participate in CMS' Bundled Payments for Care Improvement (BPCI) program to be at the forefront of learning more about healthcare payment reform, said Debbie Reber, MHS, OTR, vice president of clinical services, Brooks Rehabilitation.

We saw it as an opportunity for post-acute care providers to help make some of the healthcare policy changes related to the future of healthcare reimbursement. We also really want it to serve as a catalyst for our business to begin working better as a system of care, Ms. Reber explained during last month's webinar, Bundled Payments for Post-Acute Care: Four Critical Paths To Success, a Healthcare Intelligence Network webinar now available for replay.

Post-Acute Care Payment Bundles: Catalyst for Clinical Redesign, Improved Care Transitions

Brooks Rehabilitation achieves 19 percent savings over historic spend and reduces readmission rates to 15 percent through Bundled Payments for Care Improvement Program.

"Our move toward bundled payments was a great opportunity to improve our care transitions, our continuum," said Reber. "The other huge opportunity is to experiment with clinical redesign. As we approached bundle pay, we approached it with 'we have a blank slate. We can redesign the care to look and feel however we want it to be. If we were doing things all over again, what are the things or the gaps or cracks to the clinical care that we could really improve upon?'"

"We knew that we wanted to have a strong voice regarding future policy and payment reform changes. We really wanted to show that we were sophisticated enough to take risk and play a primary role with that continuum of care," she added.

Brooks is serving under CMS' Model 3, in which it selects from a list of DRGs. It started in October 2013 with fractures, hip and knee replacements as well as hip and knee revisions.

Brooks added congestive heart failure, non-cervical and cervical fusions and back and neck surgery bundles this past April.

"All of our bundles are for an episode length of 60 days with the only exception to that being congestive heart failure. We did heart failure for 30 days just due to the tremendous risk of managing those cases and to decrease our risk overall with that population," Reber explained.

Brooks begins its process when the patient leaves the acute care facility.

"We are then responsible for all non-hospice Part A and B services, including physician visits, DME, medications, post-acute therapy or rehab services, as well as any readmission," she said. Of particular note is that the readmissions are not just related to the acute episodes that we are seeing them for…it's for any reason that the patient would be readmitted.

Understanding what those readmission reasons are is huge to our success, Reber explained. For example, on the orthopedic side, even though the patients have just been seen for an orthopedic surgery, the primary reason for readmission is predominantly around cardiac issues or pulmonary issues that are more likely due to prior comorbidities. It's really just managing those issues more.

Brooks has achieved an overall savings of about 19 percent over its historic spend and has decreased its readmission rate to about 15 percent across the 60-day time frame within this program. And, has also seen increases in patient functional improvement and patient satisfaction rates.

During the webinar, Reber walked participants through the four domains that have been critical to its success in the BPCI program, including: using standardized assessments across care settings; patient and caregiver engagement; the in-house developed Care Compass Tool, which includes a longitudinal care plan; and enhancing the role of the care navigator.

Steward Medicare Pioneer ACO ‘Patient Trackers’ Boost Care Management, Improve Performance

July 14th, 2015 by Patricia Donovan

Steward Medicare Pioneer ACO

Steward's Medicare Pioneer ACO was a top performer in performance year two, with gross savings of $19.2 million.

The ability to track patients across a continuum of care sites is a perennial challenge for healthcare organizations—even a top-performing Medicare Pioneer ACO.

"We can't prevent a readmission back to the hospital or redirect unnecessary emergency department visits if we don't know the patients were in the hospital to begin with," noted Kelly Clements, Pioneer program director at Steward Healthcare Network, during Medicare Pioneer ACO: Care Management, Quality Improvement and Data Integration Yields Substantial Performance Gains, a Healthcare Intelligence Network webinar now available for replay.

But Steward's Medicare Pioneer ACO meets this challenge head-on with two tools: a home-grown patient surveillance tracker, and the "Patient Ping" service that provides real-time patient admissions and discharge notifications to providers. Both tools help Steward to identify and coordinate care for Pioneer ACO beneficiaries who seek services from both Steward and non-Steward providers.

These innovations have helped Steward's Medicare Pioneer ACO, aptly named Promise ("For our promise to do the best we can to coordinate beneficiaries' care and increase quality of care," said Ms. Clements), to emerge as one of the top CMS Medicare Pioneer ACO performers in 2013, with gross savings of $19.2 million.

Three Medicare Pioneer ACO Challenges

Care management, including the tracking of its 80,000 Promise beneficiaries, was one of three categories of Medicare Pioneer ACO challenges Ms. Clements touched on during the webinar, along with physician engagement and performance improvement.

Supporting care management, the internally developed patient surveillance tracker is Steward's in-network solution for real-time tracking of care received from Steward providers and facilities; the contracted Patient Ping service allows the Pioneer ACO to communicate with skilled nursing facilities (SNFs) outside their network that care for Steward Pioneer patients, providing the SNF is registered with Patient Ping.

"Through the Pioneer program, we've learned that a large portion of our opportunity to reduce cost and achieve savings as an ACO is in the post-acute care space, particularly in the SNFs," noted Ms. Clements.

To engage physicians in the delivery of accountable care, Steward has done everything from holding road shows for providers to creating performance improvement teams for each geographic "chapter" in the ACO to work with physician practices to improve efficiency and quality. Physician report cards measure stewardship (including attendance at chapter meetings) and other efficiency and quality indicators.

And finally, to drive performance improvement, Steward has worked aggressively on data integration, with a strong focus on the two most popular electronic health records (EHRs) its physician network, in order to feed its 'quality data warehouse.'

This focus, along with efforts by the physician practices, has generated results. Steward saw its Pioneer ACO raw quality scores rise significantly from performance year one to performance year two: a 39 percent jump in the preventive health domain, and a 42 percent improvement in the at-risk domain (care for chronic conditions such as diabetes and coronary artery disease (CAD).

There is one additional hurdle: Steward must decide which ACO program it will participate in next year: Pioneer ACO, Next Generation ACO or Medicare Shared Savings Program (MSSP), Track 3. "The more efficient we become, the harder it will be to achieve shared savings, because the benchmark will keep getting lower, so this is one of our big concerns," said Ms. Clements.

"Our leadership is fully committed to pursuing risk aggressively and it's been worthwhile being at the table with Medicare and advocating for programmatic changes that will benefit our providers and patients in a sustainable way."