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Accountable Care Organizations

How Baylor Scott and White’s ACO Became Top Ten in the Nation

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Baylor Scott & White Quality Alliance, the accountable care organization operated by the state’s largest nonprofit health system, saved Medicare $39.3 million through the Medicare Shared Savings Program last year. It was the highest total in Texas of reported data, and the ACO’s savings put the organization in the top ten in the nation according to the Centers for Medicare and Medicaid Services.

While ACO’s have had mixed results nationwide in their attempt to put some of the risk on the provider, local ACOs have made headlines by providing quality care more efficiently and saving CMS money. Methodist and Catalyst have both shown significant savings for CMS this year as well. ACOs are rewarded and share in the savings if they can get better results, improve population health, and lower costs.

Baylor Scott & White Quality Alliance earned $18.7 million in 2018 shared savings, putting the ACO seventh out of 548 U.S. participants. Nationwide, ACOs saved Medicare $1.7 billion in 2018. The data showed savings in a number of areas, decreasing utilization in skilled nursing, inpatient rehabilitation, and reducing long-term acute care hospitalization be over 25 percent.

For ACOs in the shared savings program, organizations must hit certain savings marks in order to get some of that money back. The benchmarks are based on past years performance for the ACO, meaning the more efficient an ACO is, the more difficult it will be to create savings in future years. But BSWQA President Dr. Cliff Fullerton is confident that savings can still be found in future years.

First of all, the savings will be using regional market rates to set the benchmarks in future years, meaning that other ACOs in the area will be factored in to create the efficiency benchmark that needs to be beat. For efficient ACOs, the regional benchmark will make it easier for future savings. In addition, Fullerton says decreasing unnecessary hospitalizations and emergency room usage and increasing virtual and video visits are areas BSWQA will find more savings in the future. “This next year we will be pulling that lever a little more than what we have,” he says.

Baylor Scott and White System Vice President of Comprehensive Care Management Jenny Reed says there are other areas of “low hanging fruit.” She says the organization will focus on disease management, targeting pre-diabetes, diabetes, COPD and other conditions that can end up with expensive hospitalizations if not treated effectively. She says the organization can also add resources to address social determinants of health such as transportation to and from appointments. “We want to reach out to patients long before they get to the hospital,” she says.

The Baylor Scott & White Quality Alliance program encompasses about 125,000 Medicare beneficiaries, making it one of the largest participants in the country. Nationwide, the Medicare Shared Savings Program cares for over 10 million people.

There were also small decreases in hospital admissions, but avoidable hospital admissions dropped 9.2 percent. The quality of care measure improved from 92.1 percent to 97.2 percent, exceeding the national average of 93 percent. Annual wellness visits for medicare patients increased from just under 60 percent to over 65 percent. These wellness visits are important for avoiding more expensive hospitalizations.

Reed says that identifying low cost high quality skilled nursing and post acute care can explain some of the savings, along with having BSW nurses coordinate care for the BSWQA patients. The oversight helps patients avoid the ER and provides information about high value physicians and facilities, though they allow patients to choose the doctor or facility they want.

“These results show not only the highest (dollar) savings in Texas but also one of the highest quality scores. This is a testament to the innovation, focus, and hard work of our teams including physicians, nurse practitioners, physician assistants, nurses and many other members that care for our patients,” said Clifford Fullerton, MD, Baylor Scott & White Quality Alliance president via release.