Secrets of the ACO That Gave Its Savings to Its Employees

When Coastal Medical of Rhode Island earned shared savings as an ACO, it did something unusual: It distributed them among all its employees. This represented leaders’ formal acknowledgement that every worker contributed to the improvements in quality and cost control.

In a blog for the Institute for Healthcare Improvement, Coastal President/CEO Al Kurose, MD, explained that decision and shared some key lessons from his organization’s ACO experience. His main points:

Shared vision—“One of the biggest lessons we have learned is about the need to create a vision of the care we want to provide, and the importance of making sure that vision is shared by everyone in the organization,” Kurose wrote. “We have to communicate and nurture that shared vision in a way that wins the hearts and minds of the providers and staff.”

Share the wealth—“We say we’re all in it together when there’s work to do. This should also be true when we have moments of success. We should include everyone when we celebrate improvements in care, and we should share financial success whenever we can.”

Focus on patient benefit—“Convey that there is a higher purpose to our efforts… People choose to work in healthcare because they want to help people. Of course, everybody likes to get a bonus, but it’s critical that we tap into people’s primary motivation for doing their work, and it’s not money.”

Lighten the load—“If you’re going to give your teams a lot of new work, you also need to take some work away whenever you can.” One way Coastal’s done that is through centralizing its prescription refill process.

“The journey into accountable care entails more than a little bit of risk taking,” Kurose concluded. “There are lots of investments we had to make to deliver new services before we knew whether we could really reduce the total cost of care. There are still many costs and components of healthcare delivery we can’t control in a primary-care-driven ACO model. We can, however, have significant influence. This new business model should be powerful enough to make our new care delivery model sustainable, and we need that sustainability to support our goal of effectively managing population health.”

Find the whole column at www.ihi.org.

Hospitals Move Quickly to Embrace Apple’s HealthKit

Major U.S. hospitals have been quick to embrace Apple’s new HealthKit capabilities, with 14 of 23 top institutions contacted by Reuters reporting they’ve initiated pilot programs using the tool or plan to.

HealthKit is a tool for developers that lets their apps access certain health and fitness data collected by other apps. Apple says more than 600 developers are integrating it into their health and fitness products.

The pilots involve projects like helping care teams monitor patients with chronic conditions like diabetes and hypertension. By spotting developing problems early, they can intervene before bigger trouble develops. New Orleans’ Ochsner Medical Center, for example, is tracking several hundred patients with high blood pressure. “If we had more data, like daily weights, we could give the patient a call before they need to be hospitalized,” Ochsner’s Dr. Richard Milani told Reuters. FierceMobileHealthcare reported that Ochsner’s pilot yielded a 44% drop in readmissions.

Another new open-source platform from the company, ResearchKit, is intended to help advance medical research. It will let iPhone users participate in studies and trials through sharing health data. Thousands have already volunteered.

IDC Health Insights predicts 70% of the world’s healthcare organizations will be using technology like apps, wearables, remote monitoring and virtual care by 2018.

Gov. Proposes Private Overhaul of Wisc. Medicaid Programs

The goal of a surprise element included in Wisconsin governor Scott Walker’s proposed budget is to improve care coordination for the state’s elderly and disabled, a state official told the Milwaukee Journal Sentinel.

Walker’s plan would significantly revamp state Medicaid programs to unite medical and long-term care, which are currently provided separately. Recipients would choose a provider from among multiple private insurance companies that contract with the state. Such a change would reportedly affect more than $2 billion a year in spending.

The key programs impacted would be Family Care and IRIS, which help poor and disabled citizens remain in their homes by providing help with daily activities. IRIS would be subsumed into the new program, and some of the organizations behind Family Care would cease operations; however, new opportunities for participating insurers would be expected to offset any losses. UnitedHealthcare and Anthem are among those who could be interested in joining up.

Medicare covered 61% of America’s long-term care spending in 2012, with an increasing amount going to home and community-based services, and states are increasingly looking for ways to integrate long-term and medical care. Only Kansas and Delaware, however, have adopted the kind of model Walker proposes.

For more, see www.jsonline.com.

King v. Burwell: What’s at Stake?

There’s a lot at stake for hospitals and integrated healthcare systems in King v. Burwell, argued before the Supreme Court in March. If the justices rule against tax credits for consumers in the 34 states that use the federal health insurance marketplace, millions could potentially become uninsured and unable to pay large medical bills.

McClatchy health writer Tony Pugh examined the potential impact on the Hospital Corporation of America, the nation’s largest private healthcare provider. HCA facilities tallied 7.5 million ED visits and 1.8 million inpatient admissions last year. Nearly 90% of its facilities are in states that use the federal marketplace.

In those 15 states, per the Urban Institute, around 5.6 million people could lose their tax credits. Of those, almost 4.9 million would ultimately become uninsured. Meanwhile, under the ACA, Congress slashed reimbursements for uncompensated care and cut hospitals’ Medicare payments and inflation adjustments. Newly covered patients were supposed to make that up, but 13 of the 15 federal marketplace states in which HCA operates haven’t expanded their Medicaid programs. That limits the number of insured patients they can treat and their resiliency to funding cuts.

“An ACA without subsidies,” a group led by the American Hospital Association said in an amicus brief filed for the case, “would leave hospitals unable to make up the loss.”

See www.mcclatchydc.com/ 2015/03/13/259689/supreme-court-case-may-devastate.html.

Greater Risk, Reward in Next-Gen ACOs

The next-generation ACO model CMS unveiled in March offers participants more predictable financial targets and greater opportunities for risk and reward than its previous Pioneer and MSSP models.

Intended for ACOs that are already experienced in coordinating patient care, the next-generation model is designed to test “whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for original Medicare fee-for-service beneficiaries.” These will carry more performance risk but also opportunity to share in more savings. Tools for improved patient engagement include improved access to services like home visits and telehealth.

Like the previous programs, the next-gen ACO is geared toward Triple Aim goals and ultimately compensating providers for quality rather than quantity. CMS expects 15–20 ACOs to participate and will report their performance on its website. The Round 1 deadline application was May 1; however, a second round will be open in 2016. Participation is expected to last up to five years.

For more, see https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model.

‘Cooperate and Collaborate Above All,’ Urge IHI Leaders

While governmental forces have gotten us started, it’s now time for leaders within the healthcare world to lead the next stage of reform, three prominent experts say in a viewpoint piece published online by JAMA in March.

The authors come from the Institute for Healthcare Improvement—President Emeritus Don Berwick, Executive Director Saranya Loehrer and Executive Vice President Derek Feeley—and speak for a new alliance of major healthcare organizations committed to further improvements under the Triple Aim.

It’s time, they say, “to move from change forced from the ‘outside in’ to change led from the ‘inside out.’” The ACA helped lead to more Americans with health insurance and new structures like ACOs and bundled payments. The imperative now becomes following through and ensuring the changes lead to the Triple Aim’s goals. Challenges with quality, reliability and safety remain.

Berwick and company offer revised care-design principles to help get us there:

• Design and nurture systems that expect and embrace change in the continual pursuit of improvement.
• Change the balance of power so health and well-being can be coproduced in partnership with patients, families and communities.
• Cultivate and mobilize the pride and joy of the healthcare workforce.
• Make it easy. Continually reduce waste and all non-value-added requirements and activities for patients, families and clinicians.
• Move knowledge, not people. Exploit all helpful capacities of the modern digital age and continually substitute better alternatives for visits and institutional stays. Meet people literally where they are.
• Cooperate and collaborate above all. Eliminate silos and tear down self-protective institutional and professional boundaries that impede flow and responsiveness.
• Assume abundance. Use all the resources that can help, especially those brought by patients, families and communities.
• Return the money from healthcare savings to other public and private purposes. Aim for total healthcare expenditures at or below 15% of gross domestic product.

Find the article at https://jama.jamanetwork.com/article.aspx?articleid=2210910.

Small Hospitals Finding Themselves Increasingly Endangered

With finances so difficult and patients getting more care elsewhere, U.S. hospitals are reducing capacity or even closing entirely. That trend should continue in coming years, an examination in Modern Healthcare concluded.
Contributing factors include the growth of lower-cost care alternatives like ambulatory-care centers; low reimbursement; high deductibles that drive patients to cheaper options; better drugs and technology; and more case management. “The shift to outpatient care, underway for decades, is accelerating,” author Melanie Evans wrote.

Hospital admissions are falling—average occupancy was 77% in 1980, 64% in 2008, 60% in 2013—leaving communities with excess beds and an aging population that won’t make up the difference. That may leave small, independent hospitals and academic medical centers most at risk. Small hospitals lack consolidation options and the capital to invest in primary- and ambulatory-care alternatives to entice patients. Academic medical centers have high costs to their education, research and specialty services.

“Many hospitals across the country are reaching a crossroads,” Evans concluded. “The median age of U.S. hospital buildings is rising, and new construction has dropped sharply, with capital going toward ambulatory-care facilities, physician hiring, information technology and telehealth. Mobile-health apps will become more prevalent over the next few years as hospitals, patients and insurers look for new ways to improve care and reduce costs.”

Find the full article at www.modernhealthcare.com/article/20150221/MAGAZINE/302219988/.