Linda Bahrke, R.N., is effusive in her support of value-based health care.
“We are seeing such good results that we want as many people involved as possible,” she says.
Who can blame her? Heartland Regional Medical Center ACO, where Bahrke is accountable care and population health administrator, has generated positive results on both sides of the value equation. Heartland Health, which recently rebranded as Mosaic Life Care, has received $5.1 million from Medicare since joining the government’s shared savings program in 2012.
Serving the northwest corner of Missouri, Mosaic’s Medicare accountable care organization covers 12,000 beneficiaries. Another 10,000 patients are involved in a commercial ACO that’s run with a private payer, which achieved $1.8 million in savings in 2013.
Mosaic is also seeing solid improvements in patient care. According to 2013 quality measures reported to Medicare, 89 percent of patients received aspirin or another antithrombotic, compared with a 76 percent mean performance rate for all ACOs. The pneumococcal vaccination rate stood at 88 percent, compared with 54 percent for all ACOs.
“We have reduced readmissions and we are keeping people at home,” Bahrke says. “For some of our high-risk patients, the adjusted risk has dropped. Those are good outcomes.”
How have they done it? Mostly through commonsense innovations like staffing medical homes with care managers who keep tabs on high-risk patients — those with one or more chronic conditions not under control. There’s also a robust electronic health record system that kicks out real-time information, allowing doctors to talk with patients about adherence to treatment regimens during their appointments, not some days later.
But is Mosaic’s experience scalable?
Judging by the dollars about to be committed to value-based pay, many are hoping that the answer is a resounding “Yes!"
Health & Human Services Secretary Sylvia Burwell last month unveiled a plan to have 30 percent of traditional Medicare payments be tied to an alternative payment model, such as bundled payments or ACOs, by 2016, increasing to 50 percent by 2018. By 2019, she pledged, 90 percent of all traditional fee-for-service payments would have quality strings attached.
On the heels of that announcement, a group of large providers, insurers and purchasers — calling themselves the Health Care Transformation Task Force — set their own target of putting 75 percent of their business into value-based arrangements tied to the Triple Aim by 2020.
There are multiple other large and small, national and regional, initiatives underway.
Getting there won’t be easy. Infrastructure costs for building an ACO can quickly add up, Bahrke notes, consuming a fair amount of the savings the design is supposed to achieve.
“Moving to a new payment model is risky,” she says. “You need to be prepared, but once you have all of the kinks worked out, move as quickly as you can.”
For those wanting to scale up, the Mosaic Life Care National Institute offers organizations a chance to learn best practices and to “reimagine health care through evidence-based leadership.”
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