Among the 32 facilities across the U.S. included in the Pioneer Accountable Care Organization (ACO) model, New York's Montefiore Medical Center achieved the highest financial performance, according to a recent report from the Centers for Medicare and Medicaid Services (CMS) Innovation Center.

Further to saving Medicare $23 million, Bronx-based Montefiore improved the quality, outcomes, and cost of care for Medicare patients in the first year of the three-year ACO model. Based on its success, Montefiore will receive approximately $14 million of the savings it generated for Medicare. The savings represent a seven percent reduction in the cost of care against the benchmark established for more than 23,000 patients attributed by the CMS Innovation Center to physicians in the Montefiore ACO.

"These funds will be reinvested in Montefiore's health care system and shared with participating physicians in the community," said Dr. Henry Chung, chief medical officer of Montefiore's care management program and of the ACO. "That reinvestment will allow the Center to continue to provide patients with high-quality, cost-effective care and continue to build out its accountable care organization."

The secret to success

The key to Montefiore's success in accountable care is focusing on the patient, according to Chung. It's all about being armed with the proper tools and experience to identify at-risk ACO beneficiaries and provide the right care management services targeted to each patient's unique needs across the continuum of care, he explained.

"Our extensive care coordination infrastructure can assist patients whether they are being treated in the hospital, in the community, at a post-discharge care facility or even at home," Chung told DOTmed News. "In addition, strong alignment with our employed and community providers allows us to quickly identify at-risk patients and offer them appropriate interventions."

However, Chung acknowledges this solution may not work for everyone.

"There is no single magic bullet to address the needs of every beneficiary," he said. "We must meet them where they are in life and health and offer myriad tools to address their needs. Our success is due to Montefiore's long-term investment in building an integrated care delivery system, which includes strong partnerships in the community with a range of health care providers and a well-developed care management infrastructure."

For example, EMR technology and experience in identifying beneficiaries' total universe of needs — including medical, mental health, and social — allow for implementation of appropriate interventions.

The Pioneer ACO Model was designed and sponsored by CMS under provisions of the Patient Protection and Affordable Care Act to provide Medicare beneficiaries with high-quality care while reducing expenditures through better care coordination. To be successful in the first year, participating organizations were required to report on 33 quality and patient satisfaction measures as well as lower costs to the Medicare program.

In all, a majority of participating health systems indicated improvement in care delivery and promise in the area of cost savings, including the ability to participate in those cost savings, according to the CMS Innovation Center's highlights from the first performance year of the Pioneer ACO model. Savings totaled $140 million, $76 million of which will be returned to the Pioneer ACOs as their portion of the shared savings. A net savings of $33 million will be returned to the Medicare trust funds.

CMS' report notes that all 32 participating health systems were able to show improved patient care related to quality and patient satisfaction benchmarks, specifically with respect to cancer screenings and controlling blood pressure.

However, only 18 of the 32 health systems lowered costs for the Medicare patients they treated and only 13 systems saved enough to share savings with the Medicare program. Two systems cost Medicare more and reportedly may owe $4 million back to the program. Further, nine Pioneer ACOs will be leaving the program.

The Center's background and lessons learned

More than 60 percent of the Medicare patients attributed to Montefiore's ACO are under the care of private practice physicians in community offices, with the remainder under care of Montefiore's employed physicians. Approximately 10 percent of patients with complex, chronic illness received intensive care management services from Montefiore. And all ACO patients have access to Montefiore's innovative care coordination programs, if needed.

Montefiore Medical Center actually functioned as an accountable care organization long before the term was coined, according to Chung. Nearly two decades ago, Montefiore began the process of building an integrated delivery system with acute care hospitals; primary care and home care programs; investments in what is now an IT infrastructure that supports coordination of care across locations; and a payment arrangement with health plans that included financial accountability and performance incentives.

"These are all elements of a successful ACO, and our experience over the years ideally positioned Montefiore to be invited to participate in the Pioneer ACO model," said Chung.

Montefiore is breaking away from the traditional, fragmented care model to create a superior academic health system that is efficient, effective and designed around the patient. Patients in Montefiore's ACO programs are routinely reviewed for potential high-risk and vulnerability factors and those identified are offered interventions and programs designed to improve their conditions. A range of interventions based on the patients' needs are offered at Montefiore, with a goal of keeping patients healthy and out of the hospital.

"For example, patients with congestive heart failure can be connected to intensive care management services, including the use of home monitoring devices and pharmacist interventions to ensure medication compliance, to help prevent readmissions and keep them at optimal health," Chung said.

In the first year of the Pioneer ACO, Chung said Montefiore learned and proved that the accountable care model works — even within one of the most economically- and health-challenged communities in the country.

Future plans

Going forward, Montefiore's focus remains on ensuring its ACO beneficiaries receive the right care, in the right place, at the right time, and have access to Montefiore's care coordination services, if needed.

Montefiore will also continue efforts to expand its ACO network by engaging like-minded providers throughout the region. In 2013, Montefiore brought on new partners from the Bronx, Brooklyn and Staten Island. In 2014, it aims to expand its network in the Bronx and Brooklyn.

"As we expand, we will continue to focus on the importance of EMR adoption among community physicians in order to further accelerate care coordination and joint quality improvement activities," said Chung.