Reform Update: Advocate Health sees progress with ACO

Advocate Health Care says that early results in operating Medicare accountable care organizations have been promising but that progress has been achieved through failure, experimentation and adaptation.

"I cannot stress enough that it does take a long time," said Sharon Rudnick, vice president of outpatient enterprise care management for Advocate and its medical group, at the American College of Healthcare Executives annual meeting in Chicago this week. Now, with more than three years of experience, Advocate's strategy continues to evolve. "Just get used to reevaluating it and changing it every year,” she advised.

Advocate was among more than 100 organizations to sign Medicare's first Shared Savings Program contract in 2012. The program was one of the cost control and quality improvement initiatives authorized by the Patient Protection and Affordable Care Act. The contracts test the accountable care model, which offers financial incentives to hospitals and doctors for meeting cost and quality targets. One year earlier, the Downers Grove, Ill.-based health system had entered a private ACO contract with Blue Cross and Blue Shield Illinois.

Shared savings contracts now account for two-thirds of Advocate's hospital revenue. "We're very much getting to a tipping point," said Michael Randall, Advocate vice president of innovation.

Advocate is preparing to expand its ACO efforts. Officials said its investments show a promise of return. "You can manage risk by managing really good quality of care," Rudnick said. "You can manage expense and revenue as well."

That optimism was echoed by other executives at the meeting who outlined strategies and results from their ACO programs. They also discussed strategies for hospitals to expand beyond acute care into prevention and disease management to reduce costs.

Peter Bernard, CEO of Bon Secours Virginia Health System, which operates nine Bon Secours Health System hospitals in Virginia, said his system's accountable care program for its own employees' healthcare resulted in a $7 million rebate for its employee health plan. "It fell to the bottom line," he said.

Bon Secours Health System also operates a Medicare ACO that began in January 2013 and includes 60,000 Medicare enrollees. Results are not yet available.

Advocate's ACO program with Blue Cross and Blue Shield Illinois has kept patients out of the hospital, Advocate officials said. But its Medicare ACO results were more mixed. Cost did not accelerate. Still, the system did not reduce spending enough to earn a bonus.

Advocate made investments in workforce and information technology to operate ACO programs. Early investments expanded Advocate's workforce to include 60 care coordinators, and it hired assistants to shoulder some of the coordinators' workload. Its networks of providers have grown as the system signed new contracts with patients with distinct needs, such as seniors who need more long-term care or expectant mothers and infants on Medicaid.

Rudnick said one problem has been limited access to timely data on patients' use of medical care and costs, which are needed to target interventions and potentially avoid hospitalization, though there has been improvement in that area. "We've been flying blind," Rudnick said. "Now, we're flying in the dark with our hand in front of our face."

—Melanie Evans

With less than a week left for customers to apply for insurance through the healthcare marketplaces, a Kaiser Family Foundation poll Wednesday found that half the people still without health coverage intend to remain uninsured, Kaiser Health News reports.

The poll, conducted in mid-March, found that 50 percent of adults under age 65 who still lack coverage plan to remain without insurance, while 40 percent aim to sign up by the deadline at month's end. The other 10 percent said they did not know what they would do or refused to talk about it.

Of the uninsured, two out of three said they have not tried to get coverage yet. The rest said they attempted to get it through an online marketplace such as HealthCare.gov, the state-federal Medicaid program, their employer or a private insurance company.

Only four in 10 of the uninsured knew the March 31 deadline to sign up for coverage, the poll found. A third of the uninsured didn't know they are subject to a fine if they don't obtain coverage. The poll found that only 11 percent of uninsured people said they had been contacted about the health law by phone call, email, text message or a home visit.

—Kaiser Health News

With the March 31 Obamacare open enrollment deadline fast approaching, a new analysis has found that HealthCare.gov, the online portal to taxpayer-subsidized health insurance, runs slowly when compared with major private health insurer websites.

The tests run by Compuware, a Detroit company that measures website performance, found that response time for HealthCare.gov averaged nearly nine seconds nationally over the seven-day period that ended Tuesday. Generally, response time for leading private health insurance websites averages just under five seconds. Based on that real-world comparison, Compuware says the speed of HealthCare.gov is "unacceptable."

On the positive side, HealthCare.gov was available more than 98% of the time, about average for the industry.

Compuware defines "response time" as the time it takes a first-time user to load the home page for a given website. The company's tests did not attempt to go through the entire process of applying for health insurance, which involves submitting personal and income details, getting the information verified by government agencies, and finally selecting a plan.

—Associated Press

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