Southwestern Health Resources, the accountable care organization run by UT Southwestern and Texas Health Resources, saved more money for the Centers for Medicare and Medicaid Services than any other ACO in 2019. North Texas is one of the more expensive places in the country to receive care, so the savings are especially impactful.
CMS launched the Next Generation ACO Model in 2017, incentivizing organizations to find savings in the care they provided Medicare patients while maintaining quality to reduce federal spending on healthcare. If the groups can find more efficient ways to care for their patients, they can keep half of the money they save. In 2019, SWHR found $52 million worth of savings across the 100,000 Medicare patients it oversees in the program, placing it at the top of the 41 ACOs that participate in the program. Since 2017, SWHR has saved $120 million and has the fourth-most participants of any ACO in the nation.
The program gives ACOs more tools to find efficiencies such as telehealth and at-home nursing to “enable a graduation from fee-for-service payment to population-based payments,” according to a statement from CMS. The shift to value-based care, where CMS pays providers for their patients’ overall outcomes rather than each procedure or test, will make the system more efficient.
The savings can’t continue forever. Each year CMS sets the targets for care a bit lower, and eventually, the ACOs will not be able to find more savings without sacrificing quality, but for the first few years of the program, SWHR has found that they can improve quality while reducing costs. So, from where are the savings coming?
Data analytics and predictive technology have been a massive boost to finding savings, says Dr. Andrew Ziskind, the senior executive officer of SWHR. ACOs can look at data to see which patients need extra attention, have missed appointments, or have not picked up their prescriptions. “We have to move from using data to look backward to data to identify which patients need extra attention so that they can either stay healthy, avoid the hospital, and avoid the emergency department,” he says.
For instance, if SWHR is made aware that one of their patients visits the ER because of a laceration, she may be at a higher risk of falling. SWHR might schedule an occupational therapist to see the patient and do a fall risk assessment and make adjustments to avoid a worse and more expensive outcome.
“Our goal is to focus on doing the right thing, in the right place, at the right time, with the right providers, and the right resources,” Ziskind says. “I think we’re continuing to break new ground as we look at new interventions that make people healthier and make health care less expensive.”
Ensuring patients make their appointments and screenings is another way ACOs find savings and improve quality, especially during the pandemic. A study in The British Medical Journal found that even a four-week delay in cancer treatment significantly increases mortality for seven different cancers. Without regular checks and screenings due to fear about COVID-19, patients are delaying their treatment. Local 911 data has shown an uptick in EMS crews arriving at crises after the patient has died, meaning more people are avoiding visiting the hospital with deadly results.
Much of the ACO’s focus is on what happens to patients when they leave the hospital. Poorly run post-acute services such as inpatient rehabilitation, long-term acute care hospitals, and home health organizations can drive prices higher while keeping patients away from their homes. Finding organizations that get their patients healthy quickly can have a massive impact at scale. SWHR is always finding ways for patients to receive care remotely or in their homes, such as an at-home eye exam or at-home testing to measure the need for a colonoscopy.
ACOs provide care management teams to measure, track, and communicate with patients to offer alternatives, send reminders, and connect patients to better and more efficient care. At SWHR, over 900 staff members provide data analysis, patient outreach, and support to physicians and their patients. Looking ahead, the ACO looks to address social determinants of health like transportation and access to food, move more care into the home, and embrace technology to continue to improve care and bring down healthcare costs.
COVID-19 vaccination is top of mind for SWHR as well. They use the same tools they use to address patient care to identify vulnerable patients and get them scheduled to receive the vaccine as soon as possible. “COVID-19 has the potential to get much worse with the risk of the new variants, which are more transmissible or potentially more virulent,” Ziskind says. “We’ve got the momentum to accelerate new models of care and better ways of using data.”