Care management program decreased healthcare charges in Pioneer ACO

Healthcare is going through a major transformation both in how care is delivered and how it is paid for across the country. These alternative payment models, like Accountable Care Organization (ACO) of Medicare, need health care delivery agencies to share in the financial risk linked with their patients' medical spending and motivate health care providers to think of alternative ways to get sufferers the care that they require. However ACOs seem to lower medical spending, there is less information on how these savings are really acquired. Today, researchers at Partners HealthCare published a study demonstrating that Partners Pioneer ACO not only decreases spending growth, but does this by reducing avoidable hospitalizations for sufferers with elevated but modifiable risks. The research appears in the month of May issue of the journal Health Affairs. Care management program reduced healthcare charges in Partners Pioneer ACO.

The research analyzed the impact of patient participation in the Pioneer ACO and its care management program on rates of emergency department (ED) visits, hospitalizations’ rates, and on overall Medicare spending. To measure the effect of ACO, and separately the care management effect, the researchers compared participation in the care management program to a similar group of sufferers who were eligible but hadn’t yet initiated the care management program.

"The significant finding was that the care management program seemed to be the mechanism through which the ACO was capable to acquire its benefits," stated John Hsu, MD, the study's first author and Director of Clinical Economics and Policy Analysis Program at the Mongan Institute for Health Policy at Massachusetts General Hospital, which is key part of Partners HealthCare. Sufferers in the care management program had lower rates of emergency department visits (94 percent of the rates of non-participants) and non-emergency visits (88 percent of the rates of non-participants), and an 8 percent decrease in hospitalizations. The longer the sufferer was in the program, the higher the reduction in hospitalizations.

"The decrease in utilization and spending are modest, but grow with sufferer participation in the program," claimed Eric Weil, MD, Chief Medical Officer of Primary Care in the Center for Population Health at Partners HealthCare, and one of the study authors. "The outcomes of the study recommend that focusing on sufferers with high risk is a key strategy and might explain the decrease in spending growth linked with ACOs."

In terms of cost savings, participation in the care management program was linked with a reduction in Medicare spending of $101 per participant each month, a decline of 6 percent. The whole ACO population, similar to comparable studies, reduced health care spending $14 each participant per month, a 2 percent decline.

"However the impacts of payment system changes are yet ongoing, this research reinforces the observation that altering care delivery takes time, but is worth the investment," stated Gregg Meyer, MD, Chief Clinical Officer at Partners HealthCare.

The care management program concentrates on chronically ill sufferers with several health problems, like diabetes, heart failure, and depression. Started at Massachusetts General Hospital in the year of 2006 as part of the Medicare Care Management for High Cost Beneficiaries Demonstration, the program now treats and handles the care for more than 12,000 complex, high risks adult and pediatric patients cared for at every Partners HealthCare primary care practice.

Sufferers are offered services by nurse care managers who work with physicians in the primary care office of patient. They establish custom treatment plans that deal any gaps in health care or social factors, like isolation and deficiency of family support. The care manager becomes the central, consistent point of contact for the sufferer. Other members of the care team involve social workers, community resources specialists, a pharmacist, and the patient's specialists. The care management group works with sufferers and their families in several settings involving the primary care office, at home, in the hospital, and in the emergency room (ER).

"The research indicates how one successful ACO was capable to acquire benefits, involving expansion from one hospital to the whole delivery system," stated Dr. Hsu. "This information can assist other health systems in the US as they contemplate entry into alternative payment models or make investment decisions to increase an existing ACO."