Most successful ACOs "shamelessly steal" ideas from others, says the CMO of outpatient services and ACO strategy at Methodist Health System. Her organization belongs to at least seven collaboratives.
There's no single prescription that will deliver positive results for an accountable care organization. The remedy lies in a variety of strategies and tactics that will engage physicians and patients in improving efficiency and patient care quality—the accountable part of ACO.
That's why it's so important for hospitals and health systems to collaborate and learn from each other.
So important, in fact, that an analysis from Premier Inc., claims that Medicare could have saved three times the amount it did and achieved higher quality scores in 2015 if all Medicare ACOs had performed as well as those in the company's Population Health Collaborative.
Since 2012, members of that collaborative, despite making up only 6% of Medicare ACO participants, have contributed 20% of total savings in the program. But it's far from the only choice for healthcare service providers to learn from each other about tactics and strategies to improve value.
Melissa Gerdes, MD, vice president and CMO of outpatient services and ACO strategy at Methodist Health System, which is a Premier Collaborative member, says help from other organizations wrestling with the same issues is invaluable.
Over a three-year performance period between 2012 and 2015, Methodist's Medicare Shared Savings ACO, the Alliance for Patient and Physicians, has saved Medicare $44.1 million resulting in a shared savings payment to the health system of $19.8 million.
Methodist Holds Membership in Multiple Collaboratives
That level of achievement would not have been possible, says Gerdes, without help from other organizations also developing value-based care strategies. In fact, Methodist, which has roughly 15,000 lives under the Medicare Shared Savings Program and an additional 55,000 lives under four commercial value-based contracts, belongs to as many as seven such collaboratives, learning from and contributing to each.
"They're very instrumental in our success," she says of the groups. "We make up very little of what we do ourselves, but we learn from peers and experts and steal shamelessly their ideas. That mitigates the experiment-and-fail process."
Critically, such collaboratives offer not only ideas on strategy, but on tools to get a handle on the huge amount of claims data that must be sorted and evaluated to identify top areas of potential savings or quality improvement.
Mining Claims Data for Cost Savings
"When you're in a value-based contract, you get a large dump of claims data for the lives you're managing, but it's all raw claims data," says Gerdes. "You need a business intelligence tool to make sense of it."
At Methodist, she and her team use business intelligence tools from Premier and other sources that help slice that data into meaningful and actionable information that can be used to make accurate predictions on ROI from a multitude of actions it recommends to intervention teams.
Business intelligence tools helped Methodist determine that its post-acute spending was three times the national average, which offered a potential $40 million savings opportunity in year one if that spending could be brought to the national average.
Focusing on post-acute as a whole was too large an action item, but home health came up as the highest potential ROI priority within post-acute, where there was huge spending variance.
Execution of a performance improvement plan with the help of a facilitator dropped home health spending from three times to twice the national average in just two years.
Gerdes, who has led Methodist's ACOs for five years, gives a lot of credit for better-than-average results to Methodist's membership in so many learning collaboratives.
"There still is no one way to do any of this," she says.
Philip Betbeze is the senior leadership editor at HealthLeaders.