Health care ‘pioneer’: Beacon Health ACO tackles health care’s ‘triple aim’ challenge
A pilot program launched in 2012 by Eastern Maine Healthcare Systems to improve patient care while reducing costs for Medicare patients has expanded into a statewide network that also includes patients covered by private payers and self-insured employers.
“We now have more than 100,000 patients,” says Carrie Arsenault, senior director of operations for EMHS's Beacon Health Accountable Care Organization, which got its start as one of 32 Pioneer ACOs selected nationwide by the federal Centers for Medicare and Medicaid Services to test how different delivery of care and payment arrangements might improve patient care and reduce Medicare costs.
Beacon Health's Medicare population has steadily grown in the four years the ACO has participated in CMS's Pioneer pilot program — from 9,000 patients in 2012, to 14,000 in 2013, to 22,000 in 2014 and 28,000 projected for this year. But the big jump in its overall numbers is driven by an agreement the ACO reached last fall with Anthem Blue Cross and Blue Shield of Maine to manage the care of more than 40,000 Anthem members. By joining forces, the two organizations became Maine's largest commercial ACO with more than 100,000 members and a shared commitment to the “triple aim” goals of improving patients' health, enhancing their experience of care and reducing overall costs.
A side benefit for Beacon Health and its network providers, she adds, is that adding non-Medicare patients to the ACO's caseload diversifies the demographics by bringing in younger and healthier populations whose care is often easier to manage, particularly when wellness and preventive care are emphasized. “From a delivery-of-care perspective, it's much easier if you can treat the majority of your patients the same way,” she says.
“We don't believe the Pioneer ACO program is the end game,” says Arsenault, explaining that the lessons Beacon Health already has learned in the first three years of CMS's five-year pilot are helping EMHS and its network providers transition from a fee-for-service payment system to a value-based payment system tied to quality measurements for patient care. “We are getting great first-hand experience in the new space that health care is moving into.”
At the same time, she says, Beacon Health's ACO network has steadily grown from its first year of being based at Eastern Maine Medical Center in Bangor, The Aroostook Medical Center in Presque Isle and Inland Hospital in Waterville and 25 primary care practices, with 111 providers. By 2014, the network included 72 primary care practices, 600 providers and more than 20 hospitals and health centers extending from Fort Kent to greater Portland. And that has very much helped its expansion into the commercial ACO arena.
“It makes a lot of sense to the private payers,” she says. “We bring a network to them … a group of providers that have signed up for this. They don't have to create their own statewide network. We can give them a solution.”
The challenge of ‘cost’
A June 2014 report by Leavitt Partners, a firm based in Salt Lake City specializing in market research about the health care industry, concludes that while the jury is still out on ACOs, their “value-based care delivery model” is gaining momentum. There are now more than 625 ACOs in the United States, with more than half only having government contracts and a little more than 200 having commercial contracts, according to Leavitt Partners. Beacon Health is among a smaller number — 74 — that have both government and commercial contracts.
Last fall, CMS published a report card on the Pioneer ACO pilot program's second year, showing that the participating ACOs had improved in 28 of 33 quality-of-care measurements — collectively improving their overall quality score by 19%, from 71.8% in 2012 to 85.2% in 2013. CMS recognized Beacon Health for being one of the top 5 of the 19 remaining Pioneer ACOs for overall quality of care and for getting high marks in patient satisfaction and engagement.
Another quality indicator is the three-year case management accreditation Beacon Health received last May from the National Committee for Quality Assurance for its nursing care coordination program — which Arsenault describes as a clinically driven measurement that's considered the industry's gold standard.
Overall, CMS reports the 19 remaining Pioneer ACOs yielded a total savings of $96 million in the pilot program's second year. Coupled with the much larger group of ACOs in the Medicare Shared Saving Program (that chose not to accept the “shared risk” element of the Pioneer ACO program), CMS pegged its total program savings for Medicare ACOs at more than $417 million in 2013.
Despite the accolades Beacon Health received for its second-year improvements in care and patient satisfaction and the cost savings it had achieved in its first year, it was one of three Pioneer ACOs whose cost of care for the covered Medicare patients was higher than the baseline set by CMS. As a result, under its shared savings and risk agreement with CMS, Beacon Health had to return $2.9 million to Medicare for exceeding its baseline target by 5.6%.
Arsenault says Beacon Health took a calculated risk in broadening both its geographic reach and the number of patients during the pilot's second year, instead of playing it safe and simply holding fast to its first-year network and Medicare population, as some Pioneer ACOs chose to do. “The way CMS established the baseline, the farther out you get and add new lives, it can introduce some volatility in your costs,” she says. “It's not fair, but that's the way it is.”
She anticipates Beacon Health's third-year costs for the Pioneer pilot might well produce the same result for 2014: Improving quality but at a cost exceeding the CMS baseline. “We're hoping to break even,” she says, noting that the final quarter's figures haven't been reported yet by CMS.
But Arsenault says EMHS and its Beacon Health subsidiary have never seen “saving money” as the overriding goal of the Pioneer ACO experiment. That's only one aspect of the triple-aim goal, she says, and there's ample evidence the initiatives to improve care — including moving toward payments based on value instead of volume — are already transforming primary care throughout the ACO's now-statewide network.
“We know we are making a difference,” she says, citing continuing declines in total hospital admissions, readmissions and emergency department admissions in the EMHS system as evidence the proactive emphasis on preventive care is helping people to stay healthy. “Patients are at the center of what we do.”
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