Accountable Care Organization Saves $4.8M With Nutrition Aid

August 15, 2017 - A case study in American Health & Drug Benefits showed that Advocate Health Care, an accountable care organization in the Chicago area, reduced healthcare costs by $3,800 per patient, or $4.8 million in total, by implementing a nutrition aid program at four of its hospitals.

“This research confirms that implementing nutrition-focused quality improvement programs, like the ones at Advocate Health Care, can help patients recover from their hospitalization faster while also removing some of the burden of financial pressures placed on health systems today,” stated Suela Sulo, PhD, a health outcomes researcher at Abbott and lead author of the study. “As providers, administrators, and payers face added pressures from rising healthcare costs, value-based nutrition interventions should be considered in all hospitals across the US.”

Hospitalizations already significantly cost ACOs and health systems, especially those participating in value-based purchasing programs that penalize providers for long lengths of stay and readmissions.

But hospital admissions involving malnourished patients cost nearly twice as much versus the cost of care for a well-nourished patient, revealed a 2016 statistical brief from the Healthcare Cost and Utilization Project. Greater healthcare spending stemmed from prolonged hospitalizations and higher readmission rates.

According to the data, the average costs of a hospital readmission across public and private payers was about $11,200.

However, the average cost per hospital readmission among malnourished patients was roughly $17,000 per patient.

To counteract high hospitalization costs and advance value-based care, Advocate Health Care launched two quality improvement initiatives in 2014 targeting malnutrition in their hospitals. The first nutrition care program involved screening all patients at admission using an EHR workflow for malnutrition risk. Patients with a score equal to or greater than 2 on the malnutrition scoring model received an oral nutritional supplement within 24 to 48 hours.

The ACO also implemented an enhanced nutrition care program. Under the enhanced model, patients with a score of 2 or more received a nutritional supplement within 24 hours of a hospital admission, nutrition education, and post-discharge instructions. They also received follow-up phone calls and coupons for retail oral nutritional supplements.

Within six months, the ACO reported significant reductions in 30-day hospital readmission rates and average lengths of stay. The healthcare utilization decreases translated to substantial cost savings.

In terms of 30-day hospital readmission rates, the study uncovered the following healthcare cost reductions:

• Compared to a baseline cohort, the basic nutrition care program dropped hospital readmission costs by 18 percent among 769 patients, totaling about $310,061 in savings from avoided readmissions

• The enhanced nutrition care program reduced costs by 22 percent among 500 patients, representing $246,400 in total cost savings from prevented admissions

• Net savings from avoided readmissions per patient was $403 for the basic program and $493 for the enhanced program, totaling $556,461 in net cost savings

• Compared to a validation cohort comprising malnourished patients receiving an oral supplemental prior to program implementation, the basic initiative reduced readmission costs by 25.8 percent, or $490,930

• The enhanced program reported a 29.4 percent reduction in readmission costs, translating to $364,000 in total savings

• Net savings from avoided readmissions was $854,930 compared to the validation cohort and patient net savings were $674 per patient

For lengths of stay, researchers found the following cost savings stemming from reduced hospitalizations:

• Compared to the pre-program baseline, the basic program decreased lengths of stay by 0.6 days, resulting in about $816,678 in cost savings for 769 patients

• Lengths of stay dropped 0.7 days in the enhanced program, translating to $619,500 in cost savings for 500 patients

• In total, the programs generated over $1.4 million in cost savings, with average patient net savings of $1,131 per patient treated

• Compared to the validation cohort, lengths of stay fell 1.8 days under the basic program, resulting in over $2.4 million in savings

• The enhanced program reduced lengths of stay by 1.9 days, generating over $1.6 million in cost reductions

• The combined savings for both programs in comparison to the validation cohort was about $4.1 million and patient net savings were $3,255 per patient

When researchers combined the healthcare cost reductions for both measures, they found that the nutrition care initiatives resulted in over $1.9 million in savings, or $1,499 in savings per patient, compared to the pre-program baseline cohort.

A sensitivity analysis that compared the program’s results to cost and patient outcomes of similar patients treated prior to program implementation revealed even greater savings. The programs produced almost $4.9 million in savings versus the pre-program validation cohort, representing $3,858 in savings per patient.

“Value-based care means looking comprehensively at patient care to identify gaps and opportunities for improvement,” stated Lee Sacks, MD, Advocate Health Care’s Executive Vice President and Chief Medical Officer. “The study's findings demonstrate that modest changes in the way we care for patients, such as ensuring patients are nourished during their hospital stay, can have a big impact in reducing costs and improving health outcomes.”