Lessons for ACOs and Medical Homes on Care Coordination for High-Need Beneficiaries
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1 Lessons for ACOs and Medical Homes on Care Coordination for High-Need Beneficiaries AcademyHealth Annual Research Meeting June 2013 Randall Brown
2 Controlling Costs Will Depend on Improving Outcomes for Chronically Ill Costs are heavily driven by small percentage of patients with multiple and/or severe chronic illnesses Payment mechanisms don t concentrate on high-risk Key to cost reductions is reducing need for hospital and ER use: Improve communications among providers, and with patients Improve patient self care Identify exacerbations early Assess/plan/implement/monitor then repeat Care coordination is difficult Generating net savings is even harder 2
3 Overview 1. What does the evidence tell us about likely effects of care coordination? 2. What are the lessons for ACOs and medical homes for producing savings for Medicare? 3. How can we increase the likelihood that ACOs will successfully implement such features? 4. What are the major barriers to success? 3
4 The Best Evidence on Effective Care Coordination CBO review of 30+ programs (Jan '12) found little favorable evidence Telephonic-only disease management programs didn t work More personal care coordination programs didn t save enough Value-based purchasing yielded little or no savings Other studies show some significant favorable effects but only for high risk patients Transitional care (Naylor, Coleman, RED) Medicare Coordinated Care Demonstration 4 sites Care Management Plus model (Dorr; OHSU) Geriatric Resources for Assessment and Care of Elders (GRACE) model (Counsell) Mass. General Hospital high cost program 4
5 Estimates from Medicare Care Coordination Demo Health Quality Partners Hospice of the Valley Mercy Medical Center Washington University Number of High-risk Enrollees (and % of all enrollees) Annualized Number of Hospital Admissions, Control-Group Mean Treatment- Control Difference % Difference P Value 273 (17) ,138 (71) (79) ,975 (71) Combined 4,290 (60)
6 What distinguishes successful interventions? Care Coordinators: 1. Have frequent face-to-face contact with patients (~ 1/month) 2. Build strong rapport with patients physicians through face-to-face contact at hospital or office 3. Use behavior-change techniques to help patients increase adherence to medications and self-care 4. Know when patients are hospitalized and provide support for transition home 5. Act as a communications hub among providers and between patient and providers 6. Have reliable information about patients Rx and access to pharmacists or medical director 6
7 Will ACOs and Medical Homes Reduce Costs? ACOs and medical homes have great potential to improve care coordination for high risk patients Link between care coordinator and PCPs should exist But success will depend on how implemented Will designated care coordinators be assigned to high risk patients? How will risk stratification be done? How good will communications be among providers within and outside the medical home/aco? Will strong educational intervention be adopted? HQP experience suggests some ACOs don t get it And evidence suggest net savings will be modest at best 7
8 How Can We Increase Likelihood of Success? To control costs, ACOs and medical homes should consider: Adopting key features of successful past programs Focusing effort on high risk patients Feeding back information to programs and physicians Building in studies of operational issues Testing replicability of proven core features in other settings 8
9 Potential Barriers to Success 1. Excessive attention to rapid cycle learning Quick answers are often wrong answers Takes time to learn, train, adapt, build rapport So use intermediate outcomes and build in tests of program implementation issues (Mahoney) Don t sacrifice rigor of evidence for speed Building on prior successes should shorten time to improvement 2. Lack of political will Failure to withstand pressure from special interests will thwart attempt to save 3. Lack of information and incentives for providers Payments or sharing of savings should focus on high risk patients Physicians need data on quality and efficiency (own and others) Payment to providers should be tied to both factors ACOs should provide this 9
10 Collaborators and Funding Co-authors of papers on which this was based: Debbie Peikes, Greg Peterson, Jennifer Schore, Arnold Chen Funders CMS Robert Wood Johnson Foundation HCFO Grant National Coalition for Care Coordination 10
11 Key References and Contact Information Key papers on which this presentation is based: Brown, R, D Peikes, G Peterson, J Schore, and C Razafindrakoto. Six Features of Medicare Coordinated Care Demonstration Programs that Cut Hospital Admissions of High-Risk Patients. Health Affairs June 2012 Peikes, D, A Chen, J Schore, and R Brown. Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials. Journal of the American Medical Association, February 11, 2009 Brown, R, A Ghosh, C Schraeder, and P Shelton. Promising Practices in Acute/Primary Care. In Comprehensive Care Coordination for Chronically Ill Adults, edited by C Schraeder, and P Shelton. Ames, IA: Wiley-Blackwell, For more information, please contact: Randy Brown: rbrown@mathematica-mpr.com Debbie Peikes: dpeikes@mathematica-mpr.com Greg Peterson: gpeterson@mathematica-mpr.com 11
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