The National Population Health Symposium’s first panel discussion focused on lessons learned from Medicare’s ACO programs. The panel featured leaders from three organizations with significant experience managing total cost for patient populations: AtlantiCare in New Jersey (featured in Dr. Atul Gawande’s article “The Hotspotters”); Montefiore Care Management in New York; and Coastal Medical Group in Rhode Island.
Dr. Lisa Bielamowicz opened the panel by putting a stake in the ground: in order to succeed under delegated risk models, providers must have “all of their business—or close” at risk. A bold statement, but a perfect segue to remarks from our panelists, all of whom have been managing total cost of care—at significant shared risk—for years.
Steven Blumberg, senior vice president and executive director at AtlantiCare, presented some fascinating and impressive results from the organization’s first year of going at risk for Medicare patients through the Medicare Shared Savings Program.
In the first year, they saw a 42% increase in primary care visits, a 25% decrease in hospitalizations, and an average of 46 touches per patient.
Montefiore Care Management
Steven Rosenthal, of Montefiore Care Management, spoke about a different market and a different approach. Montefiore is located in the Bronx, which has a high rate of Medicaid patients, as well as dual-eligible patients. Rosenthal began by sharing startling data that showed how these patients drove overall health care spending: in 2010, health care spending for Bronx residents totaled $14.8 billion. Dual eligible patients, only 66,000, accounted for more than $3 billion of that spending.
The message was clear: reducing the costs of care for dual eligible would drive significant reductions in overall health care costs for the Bronx.
Montefiore formed the Bronx Collaborative, a partnership between providers and payers in the Bronx, to address this issue holistically. They invested in actively following up with at-risk patients, collecting data through a central IT system, and focusing on delivering a best-in-class experience for its patients. Perhaps the most interesting aspects of Montefiore’s efforts are its partnerships with community organizations to provide wraparound services to its at-risk patients. Montefiore collaborated with homeless care PCPs, housing organizations, legal aid, transportation assistance, and financial service organizations to insure connectivity and communication between the providers working to ensure health care access and organizations addressing patients’ other basic needs.
After the first full year of participating in Medicare’s Shared Savings Program, Montefiore emerged the highest performer, reducing costs of care 7% for its 23,000 Medicare patients.
Coastal Medical Group
Finally, Dr. Al Kurose, the CEO of Coastal Medical Group, offered a very different perspective on care management. Unlike many who work to thrive with “a foot in two boats,” Coastal “didn’t see how it would work to dip a toe in the water” of care management, so “we decided to go all-in.” Coastal has five at-risk contracts as of 2013, which has helped them achieve their goal of coverage-blind patient care.
Achieving this goal required significant infrastructure investments, including a new CMO, 19 nurse care managers, 4 pharmacists, and a new care registry and other IT.
Dr. Kurose ended his remarks with an important note that succeeding as a population health manager requires engaging physicians in cultural change. To do this effectively, he said, organizations must rebalance physician autonomy with standards of care that help drive high-quality, low-cost care delivery.
We’ll be posting dispatches from the National Population Health Symposium on this blog across the day, so stay tuned. For shorter, real-time insights from the Symposium, follow the hashtag #NPHS2013 on Twitter.