Secrets to cost savings, quality improvement from high-performing Pioneer, MSSP ACOs

Health systems and hospitals that are members of Premier Inc.'s PACT population health management collaborative have outperformed other Medicare ACOs in the Medicare Shared Savings and Pioneer programs, reporting higher than average scores in 22 of the 33 quality measures.

Unlike many of the ACOs that struggled to achieve the metrics necessary to achieve shared savings, the Premier PACT ACOs have reported year-over-year improvements nearly double the national rate. Twenty-six percent of the 353 MSSP and Pioneer ACOs qualified for shared savings nationwide in performance year 2014. But 47 percent of the MSSP and Pioneer ACOs in PACT earned approximately $50 million in shared savings, officials from Premier announced during a press call Thursday.

Five percent of all Pioneer and MSSP organizations are members of the collaborative but represent 12 percent of the total national savings, according to Joseph Damore, pictured, vice president, population health management for Premier Inc.

Premier, a national healthcare improvement alliance of hospitals and health systems, created the population health collaborative in 2010, prior to the passage of the Affordable Care Act, to help providers develop and implement successful ACOs. More than 70 of PACT health systems, which represent 400 hospitals in 30 states, participate in the Pioneer and MSSP programs.

The participating organizations, he said, are diverse in size, scope and located in both rural and urban areas. Some have historically spent less than the national average, others a little above the national average. Yet they share some common characteristics, according to Damore. They are progressive, innovative organizations that believe in continuous learning and seek out best practices about population health management from other organizations.


There are several keys to their success, Damore noted. One of the most important: The organizations have identified its highest-risk populations--the 2 percent to 3 percent of the sickest patients who will use the most health services and coordinated care services in the post-acute setting for the population.

"In the past, no one was responsible for coordinating care, especially the sickest of the sick," he said.

Other factors for success include the ACOs' ability to:

  • Identify, communicate and engage beneficiaries
  • Select and implement a claims analytics tool
  • Establish a public and physician communications plan and office
  • Redesign care processes to achieve gains in the 33 quality measures
  • Implement a network management program
  • Create robust, team-based patient centered medical homes (PCMH) across the provider network
  • Establish and implement care management plan for high risk patients
  • Define and finalize shared savings distribution methodology
  • Develop approach for non-acute care management

Greg Wotjal, pictured right, chief financial officer at Banner Health Network in Phoenix said Banner has had success as a Pioneer ACO in all three years of the program and makes quality and saving gains year after year. In year one, the organization achieved a quality score of 62 percent and a shared savings of 4 percent or $19 million. In year three, its quality score was 88 percent and it earned shared savings of 5 percent or $29 million.

He said one of the reasons for its success is that Banner created a partnership between independent and employed physicians in order to build an infrastructure to manage the population. It expanded its acute care-centered clinical delivery model to also focus on ambulatory care and care management of the population as a whole.

"The PACT collaborative helped us achieve it due to best practice sharing. It reality no one has written a pre-determined path and so we are creating this as we go," Wotjal said.

Shaun Anand, M.D., chief medical officer for Banner, pictured right, said part of its population strategy is to segment patients into three buckets: low-intensity patients who must focus on preventive health; moderate-intensity patients who need to improve chronic conditions; and high-intensity patients with multiple conditions who visit the hospital frequently and need case management and telehealth services.

Prior to creating the ACO, Banner followed a traditional hospital model that was reactive and waited for patients to seek out services. But as a Pioneer ACO, it now is proactive. It has created an integrated care delivery model that incorporates care management, data analytics to predict the patients who need services, real-time monitoring that he refers to as "air traffic control" to monitor the patients, and seamless transitions of care.

The strategic focus areas are avoidable hospital readmissions, an expansion of its ambulatory capabilities and initiatives to make it easier for patients to access care and schedule appointments with specialists. It also aims to improve transitions and care coordination by aligning with skilled nursing facilities, Anand said.

Improved telehealth services have also helped bring care to complex patients at home.. Approximately 500 members received tablets so they can simply push a button to talk with their healthcare team and health coaches also go to patients' homes to address care gaps. The result has been a 27 percent reduction in costs of care, he said.

Amy Frankowski, M.D., pictured, senior medical director of population health-health select and chief medical officer of Mercy Health Select in Cincinnati, an MSSP ACO, said Mercy Health has had a similar journey, but is a few steps behind Banner. Like Banner, Mercy traditionally was an acute care-centric hospital system.

Its primary goal as a Medicare MSSP ACO was to expand care beyond the inpatient setting and coordinate care in the post-acute savings. She said that in 2014 the organization achieved shared savings of $15 million and has reinvested its infrastructure and the population it serves.

Mercy Health Select was created in 2012 and includes 23 hospitals and 1,600 employed and affiliated physicians across 450 sites in seven geographic locations of Ohio and Kentucky. Its care coordination program used claims data and clinical data from its EHR system to identify high-risk patients with chronic conditions and assign care coordinators to them. The result was a significant reduction in admissions, readmissions and ER visits and better disease control, she said.

Its key strategies for transformation, she said, was having a common EHR system and a data integration tool that all hospitals, practices and community physicians and post-acute settings could access. It allowed practitioners in all settings to view the common record of one patient. Mercy Health also worked with physician leaders to use the data in new ways and help transform primary care practices.

Other factors for success, she said, included creating metrics for ambulatory care and benchmarking against other Premier PACT organizations.

To learn more:
- here's the announcement and access to press call recording and slides