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Accountable Care Results for St. Luke's First Year

By Roya Camp, News and Community
January 27, 2015

 In years two and three, Accountable Care Organizations are evaluated based on a combination of performance and reporting. St. Luke’s Health System will focus on improving performance in several areas that represent the greatest opportunities to impact patient care, including fall screening prevention. St. Luke’s was ranked among the 60th percentile in this area. Fall screenings can go a long way in preventing accidents that lead to serious injury or death.

St. Luke’s was selected as a Medicare Shared Savings Program (MSSP) Accountable Care Organization on January 1, 2014. The results from the first year of the three-year commitment have been released, and the findings highlight opportunities to improve patient care in some very key areas.

When Dr. Pate wrote about St. Luke’s becoming an Accountable Care Organization in January, he shared that he had told St. Luke’s executives MSSP participation was a worthwhile investment in order to learn more about how to provide accountable care to the populations served by St. Luke’s. The reason to participate was not based on the expectation of any significant financial benefit.

Participation in this program provided a closer look at a specific population by reporting on 33 measures that were evaluated based on quality and service. In that population, there were 24,865 Medicare beneficiaries identified as potential participants in this program, and 24,234 agreed to participate. During the first year in the program, each ACO was evaluated for successful participation based only on the ability to report complete and accurate information on each measure.

Go here (slcoordinatedcare.org) to see a detailed summary of our first year in the program.

Benchmarks were set during this first year in order to establish a performance rate that each ACO must achieve in order to earn quality points for each measure in subsequent years. The reporting requirements will be phased in during the second and third years in the program. The data for our ACO was collected from a combination of sources, including electronic medical records, data from the Clinical Integration Scorecard, and Medicare claims data.

This organization saved nearly $5 million in the first year of participation. However, St. Luke’s did not meet the required 2.4 percent minimum savings rate that would have resulted in a payment back to our organization. The topline revenues simply weren’t high enough to generate the shared savings. In fact, this community falls below the national average for total cost of care, and that influenced our overall revenues.

Keeping the original goal in mind (to improve the health of the people within the communities served by St. Luke’s), the metrics received from the first year in this program strongly support that goal and provide valuable data demonstrating how to improve and where to focus efforts even further.

In years two and three, ACOs will be evaluated based on a combination of performance and reporting. As a result, during the next two years in the program our focus will be on improving performance in several areas that represent the greatest opportunities to impact patient care, including:

  • Fall Screening Prevention: St. Luke’s was ranked among the 60th Fall screenings can go a long way in preventing accidents that lead to serious injury or death. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of fatal and non-fatal injuries in people ages 65 and older. Those rates have increased sharply over the past decade and were the cause of $30 billion in direct medical costs in 2012.
  • Depression Screening: Again, St. Luke’s was ranked in the 60th According to the Centers for Medicare and Medicaid Services (CMS), one in six individuals over the age of 65 experience depression, and it is estimated that depression in older adults occurs in 25 percent of those with other illnesses. An annual screening can help people recognize possible symptoms and learn more about treatment options.
  • Mammography Screenings: MSSP results placed St. Luke’s in the 40th The CDC recommends women ages 50 to 74 should have a mammogram every two years. Studies show that mammograms can sharply reduce deaths connected to breast cancer because it often leads to an earlier diagnosis. While the decision of whether or not to get a mammogram is up to each individual, everyone deserves the opportunity to learn why the screenings are important and what their options are regarding screenings.
Our goal is to earn a score placing us in the 90th percentile in the measures listed above. There is much work to do, but it is worth the effort because it will result in healthier people within our communities.

Participating in this program is worthwhile because it enables us to measure our performance in key areas and holds us accountable to a higher standard of care. This program gives us the opportunity to join other like-minded organizations in harnessing new and innovative ways to improve the health of the people in our region.

As we move away from the fee-for-service model and get closer to a fee-for-value approach, we must master the concept of population management. To make that happen, we must step up our efforts in prevention and health maintenance.

The next two years present a valuable opportunity to move the dial in how we care for the people in our communities.

About The Author

Roya Camp is managing editor and executive communications coordinator for St. Luke’s Health System.