Advocate Aurora Invests in People, Infrastructure for ACO Success

October 15, 2019 - Accountable care organization (ACO) success was no stranger to physicians at Advocate Health Care and Aurora Health Care. Now that the two major health systems are combined, the new organization’s three affiliated ACOs are continuing on the path to improved care quality at lower costs.

CMS reported earlier this month that ACOs in the Medicare Shared Savings Program saved $739 million, with nearly all ACOs satisfactorily reporting quality measures and meeting quality performance standards in 2018.

Notably, about two-thirds of the ACOs participating in the program that year reduced their costs compared to a CMS-set spending benchmark. However, only about 37 percent of the ACOs saved enough to share in the savings that year, CMS said.

Qualifying for shared savings payments while also coordinating care is an enormous task. But ACOs affiliated with Advocate Aurora Health have stepped up to the challenge.

In 2018, Advocate Aurora Health’s three ACOs saved a combined $61 million under the MSSP while also ranking among the largest ACOs in the nation, the health system announced. Of note, the ACOs realized the greatest taxpayer savings in Illinois and the second highest in Wisconsin.

READ MORE: Understanding the Fundamentals of Accountable Care Organizations

Like many of their peers, the ACOs have focused on optimizing post-acute care use, leveraging data to improve care quality within their networks, and implementing analytics tools to get ahead of costs and adverse outcomes. While the ACOs are still developing and supporting these capabilities, Advocate Aurora Health’s chief medical officer Gary Stuck, DO, FAAFP, attributes ongoing ACO success to the right investments.

“We’ve had a great bit of investment in people and infrastructure,” he recently told RevCycleIntelligence.com. “But we think it's a great investment to provide our patients that coordination of care, which results in more affordable healthcare.”

Care managers

Advocate Aurora Health makes investments in people and infrastructure based on one overarching goal: ensuring patients get the right care at the right place. As part of this mission, the health system recently expanded its investment in care managers for ACO success, Stuck explained.

The health system started investing in care managers a couple of years ago in an effort to create a post-acute care network that would ensure patients go to the right setting after discharge. To facilitate that, the health system embedded clinicians in high-quality skilled nursing facilities to reduce costs, unnecessary emergency room visits, and avoidable hospital readmissions.

And care managers have been successful. Even this year, Advocate Aurora Health reported a reduction in skilled nursing facility and home health expenditures due to “effective and continued partnerships” with their post-acute care network.

READ MORE: 3 Strategies to Help Accountable Care Organizations Boost Savings

To build on that success, Advocate Aurora Health has embedded care managers across the care continuum.

“We have embedded care managers in our primary care practices, and they help patients navigate a complex system,” Stuck said. “We have care managers in our emergency rooms to make sure the patients get to the right setting for care. We have care managers that help coordinate discharges from the hospital. They are also in outpatient and post-discharge settings like the skilled nursing facility, home care, and back to the ambulatory setting.”

Using care managers, the health system anticipates greater care coordination, which is the ultimate goal of the ACO.

According to CMS, an ACO is a group of physicians, hospitals, and other healthcare providers who band together voluntarily to coordinate high-quality care for patients. By providing coordinated care, the federal agency believes providers can furnish high-quality care at the lowest possible cost.

Care managers are helping ACOs realize success.

READ MORE: Time Helps Accountable Care Organizations Realize Savings in MSSP

CMS identified embedding care managers in the emergency department as a best practice for Medicare ACOs. The agency also found that care management teams were a key to success for Next Generation ACOs.

Getting everyone on the same EHR

Having all providers using the same technology is another way Advocate Aurora Health is achieving the goals of the ACO model.

EHRs are crucial for value-based care. The systems allow providers to identify high-risk patients, track care outside of the ACO, and create performance data feedback, the Patient-Centered Primary Care Collaborative and the Robert Graham Center reported last year. But most importantly, the systems support care coordination, the organizations found after analyzing high-performing ACOs.

Unfortunately, data sharing and interoperability issues prevent providers on different EHR systems from seamlessly sharing information and coordinating care in the virtual space.

Health IT vendors, technology workgroups, and other industry stakeholders are busy trying to solve the problem of EHR interoperability. In the meantime, successful ACOs like those affiliated with Advocate Aurora Health are getting their providers on the same system to coordinate care.

“In Wisconsin, our clinicians are all on one EHR platform, and this has enabled them to coordinate care,” Stuck said.

To further their care coordination efforts, Advocate Aurora Health put their employed physicians on the same EHR platform last December and the health system has plans to get all of its hospitals in Illinois on the same platform within three years, Stuck reported.

“This is a tremendous commitment from our health system,” he said. “It's very, very expensive, but we believe it's the right thing to do to coordinate care across the continuum and across geographies. If a patient is traveling, we can obtain the records and make sure that we're not duplicating unnecessary testing such as CT scans or x-rays. We think this will create a better, safer environment for our patients as well as reduce costs.”

Having the right people, infrastructure elevates ACO performance

Investing in care managers and a uniform EHR system are just a couple of the strategies Advocate Aurora Health uses to reduce costs and improve care quality through their ACOs. But the investments in people and infrastructure are allowing the health system to venture into new spaces, such as social determinants of health, Stuck emphasized.

“We know that only about 20 percent of medical care contributes to the overall care of the patient and the other 80 percent comes from social determinants. So, areas such as transportation, housing, and financial security are important,” he said. “Since we have a responsibility to care for our patients and help them to achieve optimal health, we see addressing social determinants not only as a responsibility, but also as an effort that will help us provide care in the right area and improve access for patients.”

An example of how Advocate Aurora Health is addressing social determinants of health is the implementation of NowPow.

According to the health system’s 2019 Value Report, NowPow is a mobile-enabled messaging and referral platform that enables the health system to “prescribe” non-medical resources to address patients to care.

The technology has been a valuable resource for care managers. Care managers and other providers already screen patients for food, housing, and transportation security. But the platform uses that data to query a database of over 11,000 community resources to link patients to services in their neighborhood, and it closes the feedback loop with clinical and community service providers.

“We have seen this as an amazing tool for providing great care to our patients and connecting the dots with the other care that we're giving them,” Stuck said.

Currently, only care sites on the south side of Chicago are live on the platform, but Advocate Aurora Health plans to expand the use of the tool across the health system.

Stuck foresees success with the expansion of the tool, especially once care sites across the health system are on the same EHR system. The expansion of the same EHR across the health system will enable more providers to screen for social determinants of health, a capability he has already observed among clinicians in Wisconsin who have been on the same EHR for some time now.

Addressing social determinants of health will be key to future ACO success. As the health system continues to optimize post-acute care, care transitions, and other areas ripe for cost reduction, exploring new ways to influence care using people and technology will be critical to providing the coordinated care required for ACO success.