Description

In 2011, several healthcare entities came together to create the Trinity Pioneer ACO, then known as Trinity Health Systems - CMS Pioneer ACO, in northwest Iowa. Originally 1 of 32 planned organizations using the Centers for Medicare and Medicaid's Innovation Center's Pioneer Accountable Care Organization (ACO) model, its success took it to the final stages, positioning it as one of the final 19 Pioneer ACOs. Trinity is now part of CMS's Next Generation ACO Model.

Under the UnityPoint Health umbrella in Fort Dodge, Iowa, founding groups within the ACO included the Trinity Regional Medical Center and the Trimark Physicians Group. These organizations were similarly structured to the recommended ACO framework and didn't incur some of the usual start-up expenditures for specialty physicians and programs. Critical Access Hospitals were not part of the ACO. In addition to using traditional case management and high risk management strategies, Trinity also incorporated palliative medicine.

The following video from Trinity Pioneer touches more on its ACO project.

The Pioneer ACO Model was designed for health care organizations and providers with established practice models using care coordination. The Pioneer ACO Model ends in 2017 and Trinity has moved into the new Next Generation model.

Services offered

Under the original Pioneer Participation Waiver, Trinity Pioneer ACO formed an advanced medical team (AMT) for patient care. An AMT includes various health experts such as doctors, nurses, pharmacists, therapists, and social workers that support the primary care provider (PCP) in the care of complex and chronically ill patients.

AMT services included:

• Ongoing monitoring to prevent unplanned hospitalizations and re-hospitalizations
• Earlier discharges from hospitals while ensuring continuous care
• Development of a medical home
• Integration of community-based care and programs

The original ACO also provided integrated chronic care disease management training for its healthcare providers and community partners. These healthcare experts then teach patients 55 years of age and older methods to manage chronic illness. Topics included:

• Pain control
• Step-by-step personalized plans to improve health and quality of life
• Healthy eating tips
• Medication use review (medication reconciliation)
• Treatment choice education

Trinity offered several other unique services through the original ACO program which included:

• "Care at home" hospital discharge referral:
  Patients with high-risk health conditions received 1-2 free in-home visits within 1-2 days after being released from the hospital.
• "Care at home" clinic referral:
  Patients with high-risk health conditions received follow-up care by way of an in-home visit by a nurse and phone calls on a set schedule for further help.
• Three-day skilled nursing facility waiver:
  A program covering nursing home services for beneficiaries with certain conditions needing that specific level of care without requiring the usual prior 3-day inpatient hospitalization stay
• Wound care program
• Nursing home telehealth for palliative care
• Phase ll cardiac rehab as a free supervised outpatient exercise and education class for heart failure patients

Results

Under the Pioneer model, if Trinity met or exceeded the required savings rate of the given year, the ACO was to collect 70% of the generated returns while CMS retained 30%. (Savings having a positive correlation with quality measures.)

Trinity Health Systems' notable results included:

• Highest patient satisfaction among Pioneer ACOs
• $70,000 savings realized per palliative consult per 1,000 population
• Almost 100% of oncology patients receiving concurrent palliative care

Challenges

Reaching savings within predetermined CMS formulas

Replication

The discussion here centers on Trinity's previous involvement with this pilot CMS ACO payment model. The organization is now involved with the Next Generation ACO Model.

For organizations looking to replicate an ACO-like model, palliative care emphasis might offer an advantage. Some of healthcare's costliest interventions can be at end-of-life or for chronic illness. When provided alongside usual care, palliative care is proven to reduce symptoms, improve quality of life, increase patient satisfaction, enhance communication with physicians, and improve survival overall. These are all factors helping any healthcare organization achieve quality goals and savings.

Contact Information

Pam Halvorson, Executive Sponsor
Unity Point Health - Fort Dodge
515.574.6521
Pam.Halvorson@unitypoint.org