As more Medicare and Commercial ACOs appear on the horizon, focusing on strategies that can help us succeed — along with short-term practical metrics for accountability — is critical. Nicholas Stine, MD, Dignity Health Senior Medical Director, Value-Based Care, Population Health Management, offers these four key strategies that can help drive our success for 2019:
- Proactive engagement of complex and frail elderly patients.
There’s an emerging evidence base that the majority of potentially preventable Medicare spending is concentrated within the frail elderly. We’ve conducted some initial analyses to better characterize them in our MSSP data. Interestingly, while they have high costs, they are not always the same patients we identify using other risk scoring methods.
- Increase the use of Transitional Care Management (TCM) coding.
TCM services, which involve close and careful engagement of patients following hospital discharge to transition them back into continuity primary care, are associated with an impressive 11 percent reduction in total costs and 37 percent lower 60-day mortality (see study attached ). These services are also heavily underutilized. As our updated TCM toolkit is now complete, we have an opportunity to map out the process — particularly in how Care Coordination and primary care practices work together to scale up TCM utilization across the networks.
- Focus on post-acute and skilled nursing care.
Post-acute care is the greatest source of Medicare spending variation nationally. Bringing together the different work and programs impacted by post-acute care spending (particularly SNF and inpatient rehab services) to organize a more comprehensive current state assessment, gap analysis and its corresponding strategy are key for success. This is a complex undertaking, but national data and our BPCI experience clearly demonstrate that PAC is a highly modifiable spending area and must be considered a core strategy.
- Reducing Part B/Specialty Drug costs.
We have an excellent use case in Macular Degeneration and the use of Avastin as a significantly more cost-effective treatment than other anti-VEGF biologics, with no clinically significant differences among them. We must ensure its success while also expanding into a broader strategy for managing Part B/Specialty spending.
Establishing and refining these strategies will be critical for ACO success across our markets.