Healthcare Business News

Why one Medicare Pioneer ACO succeeded in saving money

By Jessica Zigmond
Posted: July 16, 2013 - 6:00 pm ET

How did Beth Israel Deaconess Care Organization meet Medicare's cost targets and receive substantial shared savings in the first year of the Medicare Pioneer accountable care organization experiment?

“We use a sophisticated computer algorithm and see who's at risk for hospitalization,” said Dr. Richard Parker, chief medical officer for the Boston-based ACO, which came in 4.2% below its budget target and produced more than $15 million in shared savings, which it split with Medicare. “Then we run that data past the primary-care doctors and develop care-management resources as appropriate.”

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Only 13 of the 32 Pioneers produced enough savings to share some of that money with the CMS. Those 13 yielded gross savings of $87.6 million in 2012, saving about $33 million for Medicare.

Successful Pioneer participants and outside experts say refined data analytics were essential tools that helped them achieve the savings. “Some of them are using a lot of predictive analytics to identify the at-risk patients more easily,” said Don Fisher, president and CEO of the American Medical Group Association, many of whose members are participating in the Pioneer program.

Beth Israel Deaconess, which served 30,000 attributed Medicare beneficiaries in its Pioneer program in 2012, used data to target high-risk patients for tailored services. Its sickest homebound patients who received care in hospital emergency departments benefited from the organization's nurse practitioner home visit program, which involved nurse practitioners seeing these patients at least monthly. Similarly, registered nurses serving as care managers helped the next-lower tier of sick patients through both telephonic and personal visits.

Parker also attributed much of Beth Israel Deaconess' success to its primary-care division's pod leadership structure. Since the hospital system has a wide geographic reach that includes northern Massachusetts, Cape Cod, and suburban Boston, it established 21 primary-care pods, or groups of physicians. Each pod has a primary-care physician leader who thoroughly understands how to manage patient health on fixed payments. That leader communicates with colleagues about care management and utilization of services.

“It's necessary to have a primary-care structure in order to communicate with all primary-care physicians what the programs are,” Parker said. “And to understand how to continually improve quality and decrease unnecessary utilization.”

Fisher said his organization has a subsidiary called Anceta, which uses a tool developed by Humedica that gathers data and allows providers to see where they stand on respective benchmarks. “It's one thing to give providers a lot of data, but it's another thing to sit down with the data and re-engineer care processes,” Fisher said.

Earlier Tuesday, Fisher released a statement that said that “an overwhelming majority” of 25 AMGA members participating in Medicare's Pioneer ACO program will stay in the program, while the remainder will either transition into the Medicare Shared Savings Program or opt out of Medicare accountable care.

Follow Jessica Zigmond on Twitter: @MHjzigmond

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