Calendar year 2014 was a successful year for Kentucky Accountable Care Organizations and the Medicare beneficiaries they serve. Eight ACOs have Medicare beneficiaries residing in Kentucky assigned to them, and five of these saved Medicare significant dollars – over $46 million total. Additionally, some of these organizations showed improvements in Quality Metrics that CMS measures over previous years.
Quality Independent Physicians (QIP) an independent, physician-led accountable care organization serving Louisville, Lexington, and Southern Indiana residents, is a leader among Kentucky ACOs for calendar year 2014 with high performance numbers across the board for both shared savings and quality score.
QIP saved Medicare over $13 million in 2014, a number exceeded by only one other ACO serving Kentucky residents. This figure generated a shared savings payout of over $6 million. In addition to impressive monetary figures, QIP also received the highest quality score of all Kentucky ACOs that earned shared savings in 2014 at 90.89 percent.
“Everyone involved with our ACO committed themselves to delivering high-quality, high-value, cost-conscious care from the beginning,” said Quality Assurance and Improvement Committee Chair Gregory Hood, MD.
Savings for Medicare
Accountable Care Organizations networks of providers and facilities who have committed to deliver a standard of care that ultimately reduces unnecessary medical spending and addresses chronic conditions more effectively. When an ACO achieves savings for the Medicare program, it is awarded a portion of those savings to be distributed at its discretion.
Composed of 41 primary care physicians from 20 area offices, QIP’s success is attributable to thorough communication and a strong desire for continued improvement, yielding consistently high quality performance since 2013. The ACO’s member offices invested significant energy in helping chronically ill patients better manage their conditions.
“This level of dedication attracted the interest of national organizations and the American College of Physicians and Prescribers’ Letter, who partnered with us in quality improvement initiatives in areas such as diabetes, CHF, COPD and controlled substance prescribing, as examples,” said Hood.
“In each category our practices achieved significant improvements. These efforts were routinely monitored and discussed with the participating physicians. Ultimately, the engagement and improvement in these processes allowed us to include such efforts in the ACO’s bonus structure.”
Continuing Education Process
Medical Director and Compliance and Communication Committee Chair Michael Harper, MD emphasizes the continuing education process: “We spent a tremendous amount of time and effort educating our COPD and CHF patients on their disease process,” Harper said.
“We discussed signs and symptoms of worsening and when to come in and see their doctor. We also had to re-train our front office staff about the importance of getting these symptomatic patients in quickly to avoid hospitalizations.”
Advance Payment Model
QIP is an Advance Payment Model participant. Among 353 ACOs in the country, only 35 are granted participation in CMS’s Advance Payment Model, a supplementary incentive program that awards partial capital needed to fund an ACO. QIP allocated these funds to comprehensive case management and a health information exchange (HIE), in addition to other carefully selected components.
Not one to rest after a successful year, QIP’s leadership understands the challenges faced by ACOs moving forward. “Our physicians have found the ACO model led to higher quality care,” said Greg Ciliberti, MD, Medical Director and Chair of the ACO’s Transitional Care Coordination Committee.
“However, I am concerned about the sustainability of the model since the CMS benchmark declines each year as savings are generated, while the patients age and inevitably develop more chronic diseases over time. This forces us into a situation of needing to constantly add new providers and beneficiaries for any hope of long term success.”
|ACO Name||State(s) where beneficiaries reside||Total Beneficiaries||Total Savings||Savings Per Beneficiary||Quality Score|
|Quality Independent Physicians, LLC||Kentucky, Indiana||12,618||$13,611,421||$1,078.73||90.89%|
|Jackson Purchase Medical Associates, PSC||Kentucky, Illinois||4,845||$4,964,871||$1,024.74||89.56%|
|Mercy Health Select, LLC||Ohio, Kentucky, Michigan||64,739||$15,441,442||$ 238.52||86.15%|
|Southern Kentucky Health Care Alliance||Kentucky||5,059||$6,670,157||$1,318.47||78.17%|
|KentuckyOne Health Partners, LLC||Kentucky||27,315||$5,606,961||$ 205.27||78.07%|
-Kellie Doligale is the Communications Specialist for Precision Healthcare Delivery in Louisville, Ky.