Beacon Health Accountable Care Organization

Description

In 2012, Northern Light Health, which serves the state of Maine, through its population health member, Beacon Health, began an Accountable Care Organization (ACO) network. Beacon Health partners participate in the Medicare Shared Savings Program (MSSP).

Although family providers initially had a sense of losing control due to ACO quality measures and guidelines, they realized that the thorough data required by CMS helps them provide more seamless and personalized patient care in the long run. Providers participating in the Beacon Health network now have concrete information to support continual process improvement that encourages and promotes consistent care. Patients are experiencing improved quality of life and care that is tailored to their needs and more affordable. Making healthcare more proactive and offering specialized care management, the network is achieving cost savings for Medicare, employers, and patients.

As an ACO, Beacon Health is able to support primary care medical home teams. Being a part of larger organizations gives smaller practices the opportunity to invest in people and programs such as licensed social workers who would have been out of budget range otherwise. Practices also have potential access to new grant funding. The real-time data, human capital, and other general resources are tools many rural sites would not gain access to on their own.

Services offered

• Clinical coordinators who help patients understand healthcare and provide guidance to the most appropriate clinical and social services for them
• Specialized nurse care manager for patients with a chronic disease, recent emergency department visit, or discharge from a hospital or skilled nursing facility
• Community care teams, including nurses and licensed social workers, who help patients with social services in their homes and local communities
• Data surveillance and analytics. This infrastructure is imperative in tracking quality measures and metrics not only required by Medicare but also health insurance providers
• Patient feedback systems, patient representatives attending the Beacon Health monthly Population Health Conference, and advisory group gatherings for parents and providers

Results

Since 2012, Beacon Health grew from a network of 9,000 Medicare beneficiaries to nearly 28,000, as well as commercial plans including nearly 18,000 employees and dependents on the Northern Light Employee Health Plan. The program cares for roughly 105,000 individuals across Maine, most of whom reside in rural areas. The Beacon Health high-value network now has 114 primary care practices and 559 providers.

In 2013, the Beacon Health nurse care manager program was accredited by the National Committee for Quality Assurance. In 2014, Beacon Health was ranked 2nd among ACOs based on 33 ACO quality measures required for observation by Medicare.

The cost-saving measures initially targeted by Beacon Health ACO were potentially avoidable emergency department visits and hospital admissions and readmissions.

Shared savings included:

• First Agreement Period
  • Performance years 2016-2018: $0
• Second Agreement Period
  • Performance year 2019: $2,060,209; returned ACO Investment Model funding of $1,745,716
  • Performance year 2020: $4,163,076

From 2012 to 2014, per 1,000 patients:

• Hospital admissions were down 34.3%
• Medical/surgical admissions were down 46%
• Readmissions were down 71.2%

Through its Beacon Health program, Northern Light Health has observed:

• Reduction in unnecessary emergency department visits
• Reduction in avoidable admissions for asthma, heart failure, and chronic obstructive pulmonary disease (COPD)
• An increase in patient satisfaction and engagement in their care
• Coordinated care and outreach that has cut out unnecessary/duplicative and preventable procedures

Challenges

• Having nurse care managers requires the forethought in budgeting to fund these new ACO teammates.
• Data surveillance and analytics require a hefty investment.
• "Team sport" mentality can take some adjustment. It's important for providers to realize that their responsibility extends beyond their office and that they have a team to support them.
• There are multiple quality measures that providers must keep in mind, and that can be a bit of an overload. This includes answering to the hospital administration and measurements from the ACO.

Replication

Provider involvement and leadership are necessary to make an ACO work among multiple practices. In addition, nurse care managers, social workers, and data analytic experts are potentially the most important factor in managing the array of healthcare services residing within an ACO. Embedded care managers seem to be more effective than outsourced programs, as they are able to visit both patients and providers in person.

Contact Information

Lanie Abbott, APR, Director of Communications and Experience
Beacon Health
lwabbott@northernlight.org