Nurse coordination, PCMHs help Medicare ACO generate savings

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Results have been mixed for Medicare Accountable Care Organizations, but one such ACO was able to achieve cost savings and care quality for two successive years by targeting high-risk patients, according to a study published in the American Journal of Managed Care.

Researchers with the Hackensack Alliance Accountable Care Organization analyzed Medicare expenditure data and collected quality data on 33 measures from Medicare claims files, a chart review of physician notes and a Medicare patient experience survey of ACO beneficiaries. They found the ACO had fewer readmissions and admissions, as well as lower emergency department use, compared to a similar ACO group. In particular, Hackensack Alliance saw far more patient office visits, which improved outcomes across the board and particularly for patients with chronic conditions.

During the first year of the program, the ACO reported shared savings of $5.6 million, according to the researchers. They achieved $2.8 million in savings the second year, they said. 

The authors attribute the success in part to an initial requirement that its physician practices be certified as patient-centered medical homes (PCMHs). As a result, they wrote, doctors came prepared with an understanding of what was required within a value-based care system. They also cited the ACO’s implementation of nurse care coordination at larger practices for patients at high risk for readmissions from the beginning of the ACO contract. Combined, these aspects of the ACO cut waste and changed doctor behavior without changing physician practice.

“We should emphasize that we do not change physician practice, we change physician behavior. By creating the appropriate interventions, we eliminate waste in our bloated healthcare system. We learn to address patient needs better,” the authors wrote. “Although we are still good at disease management, we learn how to perform health management better from the PCMH model.”

- read the study