Baylor Scott & White Quality Alliance saved $68 million in the Medicare Shared Savings Program last year via pharmacy programs, increased engagement, and reinvestment of the previous year’s savings. It was third of 544 ACOs in the program across the country and the top ACO in the nation for savings generated in the second half of 2019. The health system’s ACO is part of the program where providers, hospitals, and suppliers are incentivized to improve health while lowering costs.
In 2019, ACOs in the program saved $1.2 billion. Baylor entered the Pathways to Success model, which means that if the provider doesn’t meet its savings goals, it is on the hook for costs above what is allotted. It incentivizes efficiency while maintaining a high quality of care. The program is part of a broader shift away from fee-for-service healthcare and toward value-based care, where providers are paid based on outcomes and not for the number of tests or procedures they do. Baylor generated the nation’s highest savings among participants in the program in the second half of 2019. The program cares for 130,000 members across the state.
“Our 2019 results demonstrate a continued commitment to making healthcare better and more affordable through provider-led care coordination and design,” said Laura Irvine, chief network strategy officer, Baylor Scott & White Health via release. “For the second year in a row, we have delivered significant savings for Medicare; in fact, after we began taking downside risk in July 2019, our work generated the highest savings in the nation. As the largest clinically integrated network in Texas, we are proud to have achieved not only the highest savings in the state, but also one of the highest quality scores.”
Last year, Baylor Scott & White achieved savings by targeting high-risk patients and connecting them to the care management team to give them disease management, health coaching, and other services. This year, the savings were more challenging to achieve, and the organization launched a pharmacy team that aided in medication reconciliation, adherence, refills, and other help. They also reinvested past year’s savings to cover more members with care management services.
Care managers help patients navigate through their medications, reach out to them via text, and call to help them take advantage of their benefits. The pandemic has built upon these changes, pushing even more reluctant patients and physicians to utilize remote care.
The provider also beefed up their efforts to help patients navigate their way through the maze of facilities, from hospitals to long-term acute care facilities, inpatient rehab, and other options. “We have beefed up our efforts to make sure that we were reevaluating our decision-making process around where patients need to go when they leave the hospital,” says Jenny Reed, interim executive for the quality alliance. “We can get them to places that are now safe and weren’t as much before.”
The ACO, which launched in 2013, decreased post-acute care utilization, hospital readmissions, emergency department visits, and primary care usage through pharmacy interventions, care management, data analytics, and building relationships between patients and their physicians. The system gets to share in the savings and will have $34 million to redistribute to the system’s facilities.
The pandemic may have a mixed impact on the ACO’s ability to be efficient. While telehealth and remote care will allow patients to be more easily connected to the health system, the virus also caused many to delay care, resulting in sicker patients down the line whose care is more expensive. “I’m afraid we’re starting to see the pendulum swing the opposite direction,” says Baylor Scott & White Quality Alliance CMO Dr. Tiffany Berry. “We have a lot of people very sick and dying from other preventable issues. But I’m hoping that we’re going to see a return to people seeking healthcare.”
Each year, finding new savings becomes more difficult, as the low-hanging fruit is better managed and wasted dollars are eliminated. While the goal for the Centers for Medicare and Medicaid Services is, of course, not zero, CMS is still looking to incentivize more savings as healthcare costs go up. Managing chronic conditions is no easy task, and providers have to use data analytics, efficient care, and persuasion powers. “There’s still more to go,” Berry says. “But now we’ve got to get into changing the hearts and minds of patients, getting them more engaged in their care, and changing physician behavior significantly.”