Written by
Lisa Bernard-Kuhn
Region tests models ushered in by federal law, some of
which are already saving money and raising quality
While debate lingers about the Patient Protection and
Affordable Care Act, some key pieces of the federal health care law are already
saving hundreds of thousands of dollars and improving patient care locally.
At Mercy Health, a year-old accountable care organization is
teaming nurses with patients before they are discharged from the hospital and
at home to help manage their health and prescription regimes.
In Over-the-Rhine, patients at Crossroads Heath Center are
getting help organizing their medicines, reminders for appointments, and phone
calls from nurses to make sure they have a way to get to the doctor.
Within TriHealth, at least 19 physician practices receive
monthly payments from large employers, health insurers and Medicare for each
patient that receives enhanced coordinated care at one of its new
patient-centered medical homes.
And more than 14 physician practices that are part of St.
Elizabeth Healthcare receive monthly payments from large employers, health
insurers and Medicare for each patient that receives enhanced coordinated care
at one of its new patient centered medical homes.
Ushered in by Obamacare, the models mark the region as one
of the few in the country where so many new approaches for delivering health
care and paying for it are being tested. Each model has a different name and a
slightly different approach. But at their core, all try to curb costs and
improve patient care by focusing on primary care and managing the health of the
sickest among us.
“We’re moving away from fee-for-service payments into a
world where providers are recognized for taking better care of their patients
and keeping them healthy,” said Craig Brammer, vice president of the Greater
Cincinnati Health Council, the Health Collaborative and HealthBridge.
In the short run, several of the programs are yielding
promising results by producing fewer costly trips to the emergency rooms for
Medicare patients and improving the health of diabetic patients and others with
chronic conditions.
But longer term, the jury is still out as to which models
will have staying power. “This is the starting point, not the end point,” said
Brammer.
Boosting outcomes, payments via 'accountable care'
Locally, Mercy Health is the region’s first and only health
system to take the path of becoming an accountable care organization, in which
it shares the financial risk of keeping patients healthy.
Roughly 1,200 health-care providers across the country have
signed on to the program, aimed at managing the health of some of the most
vulnerable and costly patients: elderly and disabled patients on Medicare.
Nationally, savings from the new model are expected to be as
much as $1.9 billion by 2015, according to the federal government.
Mercy says it’s seen impressive results since launching its
accountable care group, Mercy Health Select, a year ago. Though the data are
not final, the improvements are on pace to show a nearly 50 percent reduction
in hospital admissions for the more than 25,000 patients served by the program.
It’s also expecting a 35 percent reduction in re-admissions for patients and
roughly the same decline in emergency room visits overall.
“In the past, we were used to taking care of the patients
who came to our door, or patients who showed up in our emergency room, but that
is such reactive medicine,” said Dr. Amy Frankowski, medical director of Mercy
Health Select.
Mercy’s system includes 35 patient-centered medical homes,
which includes a team-based care approach with larger roles for physician
assistants, nurse practitioners and other staff who help coordinate more
comprehensive care for patients.
Across those practices, Mercy’s 18 nurse care coordinators
employed by the accountable care organization focus their time first on the top
5 percent of the most chronically ill patients. These roughly 1,200 patients
have conditions that are most severe, complicated and, if left unmanaged,
become the most costly to treat.
The nurse care coordinators work one-on-one with each
patient, helping manage their diets and tackling any barriers – such as
transportation – that might keep them from follow up appointments.
Among the patients is 76-year-old Kathy Calhoun of Reading.
Twice a week she gets a call or visit from her nurse care coordinator, who also
helps manage the health of Calhoun’s 78-year-old husband, Paul.
The coordinator is “on top of everything,” said Kathy
Calhoun. “She’s great about making sure I’m taking my medication correctly and
she talks to me about my diet. Until her, I never had a nurse call me.”
In all, the health system says it has seen a “5 to 1” return
on its investment, saving more than $500,000 in the first year the model was
tested, with just 310 patients. Should savings stay continue to track as they
have, they could total in the millions.
Accountable care programs offer hospitals two options for
incentives.
Hospitals can take on risk immediately, in which case they
get 60 percent of any savings, and potentially face losses.
The other option, which Mercy Health has taken, allows
health systems to receive a payment worth half of the money it saved Medicare
during the three year trial. Mercy will decide in 2015 if it wants to continue.
“These are important learnings, and if they’re successful we
can expand them,” said Frankowski.
Creating 'medical homes' at St. E., TriHealth, Christ
Other large health systems in the region including St.
Elizabeth, TriHealth and Christ Hospital have taken the path of transitioning
their physician practices to patient-centered medical homes.
Roughly 75 area practices, including 19 offices at
TriHealth, are participating in a national pilot known as the Comprehensive
Primary Care Initiative.
Collectively, the practices are getting up to $60 million
more from Medicare through 2016 to improve primary care. The Greater Cincinnati
and Dayton region was one of seven nationally last spring to receive grants
from the Center for Medicare and Medicaid Innovation to help doctors afford
more comprehensive medical care, including follow ups.
“The theory is, if we can invest more on the front end with
primary care, and really engage and coordinate care, then we’ll all save money
down stream,” said Dr. Will Groneman, executive vice president of system
development at TriHealth.
The practices receive monthly fees that average about $20
per Medicare patient. Those incentives are matched with similar programs from
large employer-sponsored plans and insurers including Humana, Anthem Blue Cross
& Blue Shield or United Healthcare.
In 2015 and 2016, the monthly incentives will decrease, but
doctors can share in any savings to Medicare from the experiment.
The test is entering is its second year locally, and
analysts are reviewing data to determine how successful it’s been, Groneman
said. “We’ve heard from large employers that it has been successful in saving
costs,” he added.
Using U.S. buying power to bring broader change
Some of this has been tried before. But many of the programs
were headed by health insurance companies, and even some employers.
But the fundamental difference this time around is making it
pay to give better care.
Because Medicare is the single largest purchaser of U.S.
health care services, the way the program chooses to pay out its benefits is
followed by the private insurer market.
