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For Ongoing ACO Shared Savings, Look Outside Inpatient, Primary Care

December 08 2017
RevCycle Intelligence 
by Jacqueline Belliveau 
Controlling outcomes and costs outside of the network and in the post-acute care space will bring long-term ACO Shared savings. (read full article)
VNA Care Highlights from the article ****

Atrius Health has used a similar strategy. The ACO embedded SNF experts, who were typically nurse practitioners, in preferred facilities. After seeing a 15 percent improvement in length of stay and millions in savings, Atrius Health is expanding its post-acute care strategy to home health and hospice through its subsidiary, Visiting Nurse Association (VNA) Care.

VNA Care sends providers to patient homes for home health, palliative, hospice, and supportive care services. The strategy allows Atrius to develop one-on-one relationships with their patients and guarantee that high-risk patients receive care from affiliated providers when they need services, explained Lopez, VNA Care’s Chief Medical Officer.

Rick Lopez, MD, CMO of VNA Care and Senior VP of Population Health for Atrius Health

Rick Lopez, MD, CMO of VNA Care and Senior VP of Population Health for Atrius Health

Source: Atrius Health

VNA Care operates the Care in Place program, which connects nurses with high-risk elderly patients.

“This program primarily focused on frail patients over the age of 65 who call into one of our offices, are speaking to a nurse, and have a problem,” he said. “It's clear to the nurse that it would be good for them to be seen, but perhaps the patient can't come into the office because their daughter isn't available, or they have no transportation, or they're not feeling up to it.”

“Typically, the response will be, ‘Well, we'll call an ambulance and go to the emergency room,’ which means for a lot of these elderly patients, they get admitted.”

Instead, the program deploys a nurse to the patient’s home within two hours. Nurses perform an assessment and collaborate with geriatric nurse practitioners in the office to develop an action plan.

“We've had significant savings because we've looked at what would have happened in these cases if the nurse didn't make a hands-on evaluation of the patient and what would have been the likelihood the patient would have gone to the emergency room and had admission,” Lopez said.

VNA Care also helps the ACO to better coordinate care across other programs in the organization. For example, Atrius Health runs a total joint replacement program in collaboration with VNA Care.

“We have a physical therapist go into the patient's home, make a home assessment, and educate the patient on what to expect,” he said. “Then, when the patient has their total joint replacement, they go directly home to begin rehab with VNA Care instead of going to a skilled nursing facility for a seven or ten-day length of stay.” 

Qualifying for shared savings payments is a continuous process for ACOs. Ideally, organizations should be decreasing total care costs more and more each year. But at some point, organizations will have acted on the more obvious cost savings opportunities within their organizations.

Looking beyond the hospitals and primary care practices within an ACO’s network is the next frontier for organizations seeking shared savings payments. Excessive patient leakage and low-value post-acute care partners can easily spike healthcare costs, even if ACO providers delivering the highest quality care at the lowest possible costs.

ACOs should consider where their networks are failing to meet patient demands and how their providers can partner with the resources in the community to fill gaps with high-value care. Expanding beyond the hospital and practice will be the next steps for ACO success, Wilson stated.

“With an ACO model, you can’t keep taking branches off the tree,” he said. “Eventually, the tree is no longer. So, we are looking to see what the next steps are as we use these learning opportunities for value-based purchasing. What CMS chooses to do with the benchmarks or not will really make a difference to see whether this ACO model, in and of itself, is going to be effective.” 

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