BOSTON, Jan. 22, 2019 /PRNewswire/ -- In 2017, the first year that Partners HealthCare participated in the Next Generation Accountable Care Organization (ACO) Model, the Partners system successfully provided quality care to approximately 88,000 Medicare patients, making it one of the largest Next Generation ACOs in the country. Partners also limited cost growth by beating the Medicare performance benchmark by 0.1%, while remaining among the best ACOs in the nation for delivering high quality care to patients, achieving a quality score of 100%.
As one of the first Medicare Pioneer Accountable Care Organization Model participants in the country, Partners HealthCare generated $36.7 million in cost savings for the federally funded program between 2012 and 2016. When the Centers for Medicare & Medicaid Services (CMS) phased out the Pioneer ACO Model, Partners HealthCare chose to continue to optimize the care for Medicare beneficiaries by participating in a similar initiative called the Next Generation ACO Model. Building on similar models like the Medicare Shared Savings Program and Pioneer ACO Model, the Next Generation ACO Model rewards providers and health care organizations for delivering high quality, coordinated care, while keeping costs on par with a national spending benchmark. As part of the Next Generation ACO Model, provider organizations can assume higher levels of financial risk and reward and are encouraged to implement new care delivery models.
Partners' growth in expenses from 2014 (baseline year) to 2017 was lower than the growth in the United States per capita cost (USPCC) inclusive of all Medicare fee-for-service (FFS) from 2014 to 2017 (6.3% vs. 7.3% respectively). In addition, Partners was successful in keeping utilization rates (unadjusted) below that of the Reference population (National Medicare FFS) for many categories in 2017. Partners' outpatient emergency department (ED) visit rate (visits per 1,000-member months) was 404 versus 485 in the Reference population. In addition, Partners' imaging rate (tests per 1,000-member months) was 2,662 versus 2,823 in the Reference population.
Central to successfully delivering high quality care and reducing cost is the well-established integrated care management program (iCMP), which provides a strong framework for longitudinal care coordination. In 2017, 13,000 patients (of which 68% were Medicare patients) participated in this program aimed at addressing the needs of high-risk patients. Overall, Partners estimates that among ACO patients enrolled in iCMP compared to non-participants, the per member per month cost is $125 lower, the rate of ED visits is 10.5% lower, and medical hospitalizations is 15.5% lower, respectively.
"Participation in the Next Generation ACO has allowed us to expand clinical programs that reduce costs and improve quality across our clinical network," says Sree Chaguturu, MD, Chief Population Health Officer at Partners HealthCare.
Partners utilizes the three-day skilled nursing facility (SNF) waiver, which waives the Medicare fee-for-service rule requiring a three-day inpatient stay prior to admission to a SNF. This Next Generation ACO waiver establishes a set of payment incentives and program rules that allow clinically appropriate patients to avoid an unnecessary hospitalization traditionally required prior to admission to a SNF. In 2017, Partners was the third highest user of the waiver of all Next Generation ACOs, deploying the waiver 441 times. The average length of stay for waiver patients fell from 16.2 days in 2016 to 14.4 days in 2017. Additionally, Partners employs the telehealth waiver, creating opportunities for Next Generation ACO Model beneficiaries to receive services in their home or partnering medical centers. Over the last year, Partners' telehealth program has rapidly expanded across its network with over 25,000 virtual visits conducted, including video-based visits and on-line questionnaires known as eVisits. Partners has submitted approximately 95 Next Generation telehealth waivers during this same period and aims to continue growing waiver participation.
"The Next Generation ACO Model challenges us to continue to find ways for our physicians, nurses, and care team members to come together for patients across a wide variety of care settings to achieve the vision of high quality, patient-centered care delivered in a financially sustainable manner. We are pleased with our 2017 results and look forward to continued participation in the program," says Sandhya Rao, MD, Senior Medical Director for Population Health at Partners and Medical Director for the Next Generation ACO Model.
About Next Generation ACO
The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than the previous Pioneer Model and the current Medicare Shared Savings Program. The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for original Medicare fee-for-service beneficiaries.
Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services' "Better, Smarter, Healthier" approach to improving our nation's health care and setting clear, measurable goals and a timeline to move the Medicare program -- and the health care system at large -- toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation ACOs on quality metrics, including patient experience ratings, on its website.
Partners HealthCare is an integrated health system founded by Brigham and Women's Hospital and Massachusetts General Hospital. In addition to its two academic medical centers, the Partners system includes community and specialty hospitals, a managed care organization, community health centers, a physician network, home health and long-term care services, and other health care entities. Partners HealthCare is committed to patient care, research, teaching, and service to the community. Partners is one of the nation's leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. Partners HealthCare is a non-profit organization.
Contact: Rich Copp
SOURCE Partners HealthCare