Baylor Scott & White Quality Alliance generated more savings than any other accountable care organization in the Pathways to Success model for the second year in a row. It generated $96 million in savings in the Medicare Shared Savings Program in 2020.
The ACO embraces downside risk, which means healthcare providers can lose revenue if services exceed financial and clinical goals. More and more ACOs are taking on the downside risk model as the Center for Medicare and Medicaid Services pushes to move closer to value-based care and the incentives for quality and efficiency that go along with it. ACOs reward managing the care of Medicare patients, building relationships that will result in fewer costly hospital visits for high-risk patients.
ACOs started slowly and didn’t save the government money in the early years following the federal healthcare law that established them in 2010, but providers have become savvier over the years, and the organizations have had a significant impact in recent years. During the pandemic, coordinated care became even more critical.
“We have heard from ACOs that their work to coordinate care and improve quality enabled them to better respond to the COVID-19 pandemic,” said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare via release. “They were able to work quickly to transition to telehealth and continue to provide needed access to care, and they were able to provide the team-based services needed to address the full spectrum of issues arising from the pandemic, ranging from community prevention and health-related social needs to end-of-life support for patients and their families.”
In 2020, 513 ACOs saved Medicare $4.1 billion in gross savings. Baylor Scott & White, the largest clinically integrated network in Texas with 750,000 lives, received $47.13 million from the shared savings program that can be redistributed to hospitals and physicians.
So how is the system able to keep finding savings year after year? Increasing primary care visits and care management engagement help patients avoid the hospital and the emergency department. When many were avoiding healthcare facilities during the pandemic, that meant reaching out via telephone call, FaceTime, and setting up telehealth for patients who hadn’t used it before.
“It is not how we intended to deploy virtual care,” says Jenny Reed, senior vice president of value-based care at BSWH. “But at a time when folks were not comfortable because they hadn’t used it before, we had to ease them into how to use the technology in this Medicare population that is less technologically inclined.”
The Medicare population went from a 33 percent engagement rate to 54 percent during the pandemic with increased digital options via telehealth and the MyBSWHealth app. This means more vulnerable patients are in touch with their physician, know when their next appointment is, and better understand their medication. Increased communication leads to fewer unplanned hospitalizations and readmissions, improving outcomes and reducing costs along the way.
During the pandemic, this contact was even more essential, as the virus disproportionately impacted elderly patients. Providers were able to help arrange testing, set up appointments, monitor symptoms, and eventually, schedule a vaccine as the pandemic progressed. The system responded to the needs of the pandemic by expanding appointment times and incorporating more virtual visits.
BSWH uses risk algorithms and has emphasized deficits in the social determinants of health like transportation, housing, and access to healthy food to identify at-risk patients who can benefit from a greater level of managed care. The system can incorporate social factors into the electronic health record so that healthcare workers can address those needs if necessary. The increased contact also allows providers to determine if there are any additional behavioral health needs.
So what’s next for successful ACOs like the quality alliance at Baylor Scott & White? The system is looking to take on increased downside risk next year and is looking at direct contracting options proposed by CMS as well. The system is leaning into the challenges ahead. “We want to be more accountable for cost and quality,” Reed says.