Triad HealthCare Network’s ACO: A System Designed for Wellness

The US health system costs vastly more than health systems in other countries, and delivers worse results. How come?

“This is a system design problem,” said Elissa Langley, vice president and chief operating officer of the Triad HealthCare Network, an ACO based in Greensboro, NC. “Every system is perfectly designed to get the results it gets,” she added, quoting Paul Batalden, MD, of Dartmouth Medical School.

What we get in the US is “an expensive high-tech inefficient health care system” that needs to be redesigned, Langley said during a web talk for the Scottsdale Institute, a consortium of large health systems and academic medical centers that work together to share best practices on transforming healthcare through information technology.

Triad has pursued an aggressive strategy of redesign in its own health system, featuring assumption of risk for patient care. Through its affiliation with ConeHealth, Triad has put 50% of its revenues at risk: contracts covering 64,000 of its 99,600 total patients include a risk element. Of those, 30,000 are covered at 100% risk in its Next Generation ACO.

Triad’s ACO is one of the most successful in the country. It saved $25 million in costs in its first two years and received a shared savings distribution of $10,537,755. In 2015 it was one of the top 5 Medicare Shared Savings ACOs for quality.

Triad has achieved these results in part by aligning its systems around wellness. “System design matters, how medical services are paid matters,” Langley said. Considering the high amounts of care consumed by high utilizers, the ACO asked itself whether it was defining healthcare too narrowly. It took a hard look at some of the issues that high utilizers share:

  • Lack of social support
  • Lack of transportation
  • Health literacy and problem-solving skills
  • Chronic health conditions with daily management challenges
  • Pharmacy and medication barrier issues
  • Lack of patient follow-up with a primary provider

Are these issues really “healthcare,” the ACO wondered. It considered alternative approaches to resolving them. If you want to lower costs, they decided, you have to keep people out of the hospital.

Technology was a part of the solution they found. The ACO has been using scalable, proactive patient outreach programs to engage patients and involve them in their own care and prevention. It has used Emmi as a population health solution.

For instance, as part of its transitions of care outreach, Triad used Emmi to track 30-day readmission rates for four common conditions: heart failure, COPD, pneumonia, and stroke. It found that heart failure patients in its general population had a readmission rate of 19.55%, but heart failure patients who participated in EmmiTransition® were readmitted 7.55% of the time.

Likewise for COPD: the general population was readmitted at a rate of 17.39%, while EmmiTransition patients were readmitted at just a rate of 4.55%. Pneumonia and stroke had similar results.

Triad used EmmiPrevent® to boost its response rates for screenings and preventive measures.

  • In March 2017 Emmi interactive voice calls were made to 2,894 men, advising them to get a screening for colorectal cancer. Of those who interacted with the automated call, 13% had a documented screening completed within 120 days of the call.
  • Emmi interactive voice calls were made to 4,774 women that same months, inquiring whether they had had a mammogram recently. By 120 days after the call, 32% of women who interacted with the Emmi automated call had a documented mammogram.
  • In January 2017 the Emmi platform reached out to 6,743 patients to remind them to get a flu vaccination. Within 120 days, 30% of patients who interacted with the Emmi call had a documented vaccination.

“We had a statistically significant higher rate of screening or vaccine for those patients who engaged in the call than we did for their peers who didn’t engage,” said Tonda Gosnell, Triad’s manager of ACO patient engagement.

Triad used Emmi to make more than 98,000 calls in 2017. It expects to make more than 100,000 calls in 2018, Gosnell said.

“We really consider all of these positive uses of the EmmiPrevent tool. Certainly that is why we continue to expand the use of these calls.”

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