STATEN ISLAND -- In its first year of participation in Montefiore Medical Center’s Pioneer Model Accountable Care Organization (ACO), the University Physicians Group (UPG) in Staten Island and Brooklyn and the North Shore-LIJ Health System saved the Medicare program about $3.5 million compared to an historical benchmark of the cost of healthcare services delivered to nearly 5,000 of the ACO’s 23,000 Medicare recipients.
The U.S. Centers for Medicare and Medicaid Services (CMS) designed the Pioneer ACO program for healthcare organizations and providers with experience in coordinating care for patients across care settings. The program rewards providers who meet a series of patient care quality measures aimed at improving patient outcomes, while also achieving cost savings for Medicare.
The Montefiore ACO was one of the 23 Pioneer ACOs in the nation – and the only one in New York State. CMS reported recently that Montefiore’s ACO, which delivered care to more than 25,000 patients in 2013, was one of the program’s highest financial performers, generating approximately $24.5 million in gross savings.
The Montefiore ACO achieved the savings through increased care coordination and patient engagement– in the hospital, in doctors' offices, by phone or at home. Montefiore’s ACO made great strides in improving quality performance in key areas like depression screening and screening for risk of future falls. Through a unique partnership with healthcare providers in its own network, as well as those in UPG and the North Shore-LIJ Health System, clinical excellence was delivered at all points of care.
With 60 physicians on Staten Island and in Brooklyn, UPG has been a major provider of primary and specialty care for 23 years. It serves a patient population of more than 100,000 patients in the two boroughs. Although only 4,917 of UPG’s Medicare patients were part of the ACO, the UPG adapted the same 33 Pioneer ACO quality performance measures for all of its Medicare patients, according to Theodore Strange, MD, president and chief executive operator of UPG.
UPG performed particularly well on the measures related to the high-risk population, which includes patients with diabetes and hypertension. Jeffrey Hyman, MD, medical director of UPG, noted that the “Three Part Aim” of the Pioneer ACO guided physicians in this very complex program: better quality, improved patient experience and reduced healthcare spending. “Once this concept was understood at the granular level, our physicians and their staffs, led by their office managers, were able to adapt to this program,” Dr. Hyman said.
“Our physicians had a very positive attitude that we could affect change -- and the process worked well,” said Dr. Strange. “Our partners at Montefiore are very good at delivering care in the ACO model and our physicians worked very well together.” Among local hospital and long-term care providers, UPG worked in close collaboration with Staten Island University Hospital, the Eger Health Care and Rehabilitation Center and the Carmel Richmond Healthcare and Rehabilitation Center on Staten Island, all of which are affiliated with the North Shore-LIJ Health System.
Kristofer Smith, MD, vice president and medical director of North Shore-LIJ Care Solutions, the health system’s care management organization, said the health system was proud of the collaboration with UPG and Montefiore Medical Center.
“Montefiore has an excellent reputation in population health and an innovative approach to healthcare in general, said Dr. Smith. “ACOs must be able to succeed in the areas of preventative care, integrated delivery across the care continuum and patient education. North Shore-LIJ invested in care managers to work with UPG physicians, allowing for better coordination and follow up with patients.” Dr. Smith continued to say “the plan is to grow care coordination to support our current and expanding value-based programs.”
To participate in Montefiore’s ACO, UPG modified its electronic health record (EHR) to incorporate CMS’s clinical measures for its 60 physicians. Dr. Hyman and the “incentive team” at UPG were able to roll out an efficient and easy system that physicians were able to learn quickly and adopt without interrupting their work flow.
Dr. Strange noted that their deep ties in the communities have fostered the ACO’s success: “For example, Montefiore has been successful in the Bronx, and UPG has had a major presence in Staten Island and south Brooklyn for 23 years.” Results showed that during the second year of the Pioneer ACO program, participants generated a total of more than $96 million for the Medicare program, an increase of $9 million from the previous year, when more healthcare systems participated.
# # #