Tag Archives: Centers for Medicare and Medicaid Services

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Banner Health sees major gains in quality

Phoenix-area beneficiaries in the Medicare Pioneer Accountable Care Organization (ACO) served by Banner Health Network (BHN) receive a high level of quality care and preventive medicine that results in less cost to the nation’s Medicare system. Today, the Centers for Medicare and Medicaid Services (CMS) released the preliminary results for the Pioneer ACO’s Performance Year 2 (calendar year 2013) which further illustrates that point.

Recently released accountable care data from one of BHN’s payer partners in the private sector, offers similar cost and quality findings across commercial populations.

BHN’s quality score in 2013 reflected a gain of nearly 19 percent from the previous year. “Our providers are delivering high quality, coordinated care. The care they want to deliver,” said Dr. Shaun Anand, Medical Director for Banner Health Network. “They are rewarded for providing holistic care to BHN’s members and beneficiaries, and given the infrastructure, information and resources they need to be efficient and effective in preventive, chronic and acute care.”

As a top performer in the Medicare Pioneer ACO for the second consecutive year, BHN’s savings to CMS of more than $15 million made up 16 percent of the total $96 million returned by 23 Pioneers in Performance Year 2. This was possible as a result of delivering the right care, at the right time in the right setting.

“Highly engaged provider partners, information technology tools and an organizational commitment to value-based care were key elements of our success,” says Chuck Lehn, Banner Health Network Chief Executive Officer. “Supporting beneficiaries when they were most at risk and in need of medical advocacy— after a new diagnosis, following hospital discharge, or as a result of multiple emergency department visits, for example— has also been an important strategy in this program.”

BHN has continued to participate with the Pioneer ACO program in Performance Year 3 (current calendar year), and has recruited new qualified BHN physicians to further develop our Pioneer program in Performance Year 4 (calendar year 2015).

In December 2011, Banner Health Network announced that it had been selected as one of only 32 organizations in the country to demonstrate the Pioneer ACO Model. Only 23 organizations continued with the model after the first year. The central premise of the Pioneer ACO effort is to create value through a highly coordinated, collaborative network of providers who are focused on achieving the highest level of wellness and prevention possible for their Medicare patients, while addressing chronic and acute illness aggressively.

Pioneer provider networks benefit financially when they return savings to Medicare, not through increased volume of services that are reimbursed in a traditional fee-for-service model. Revenues are generated through a percentage of Medicare savings. Savings are realized through tight coordination of care and adherence to evidence-based care. If expenses are greater than the expected benchmark, that Pioneer ACO is at risk for a percentage of losses.

In addition to participating in the Medicare Pioneer ACO, BHN has developed accountable care relationships with commercial payers such as: Aetna, Cigna, Blue Cross Blue Shield of Arizona, and UnitedHealthcare, among others.

BHN is comprised of Banner Health-employed physicians and Banner Health-affiliated community physicians; 14 Banner Health hospitals; Banner Health Centers and Clinics; hospice, home care, lab and related clinical services. The Network ensures convenient access to Medicare beneficiaries with more than 3,000 providers located throughout Maricopa County and into Pinal County.

Medical Technology - AZ Business Magazine January/February 2012

Del Webb Gives $500,000 to cut John C. Lincoln readmissions

Love, they say, makes the world go round. Apparently, at John C. Lincoln Hospitals in Phoenix, love also reduces hospital readmissions by frail Medicare patients.

A program that hires military combat medics and corpsmen to care for discharged elderly patients like beloved grandparents has slashed the John C. Lincoln Hospitals’ Medicare patient readmission rates to an astonishing 6 percent.

It’s not that the rates were bad to begin with. Before the program started last October, the Medicare readmission rates at John C. Lincoln Hospitals hovered around a respectable 18 percent – the national average is 20 percent. Those readmissions cost the federal government more than $17 billion annually.

The Centers for Medicare and Medicaid Services (CMS) launched a campaign to encourage hospitals to do whatever necessary to maintain the health of discharged Medicare hospital patients with congestive heart failure, heart attacks or pneumonia, so fewer of them would be readmitted within the first 30 days after leaving the hospital. Financial incentives for readmission rate reduction and penalties for readmission rate increases were built into the CMS campaign.

John C. Lincoln’s innovative response to the CMS challenge mobilizes a cadre of veterans as transition coaches who provide designated Medicare patients with a personal touch along with support and guidance – to help them with follow-up medical instructions, prescription drugs, doctor appointments, nutrition and costs of care.

In the long run, reduced readmissions generated by the transition coaches produce significant savings for John C. Lincoln that far exceed program costs. But initial assistance to maximize the program’s effectiveness was needed.

The Del E. Webb Foundation stepped into that gap and awarded a $500,000 two-year grant to John C. Lincoln Health Foundation to support and expand the Health Network’s transition coach services. The grant will provide $250,000 this year to hire an additional five coaches, plus an additional $250,000 in July 2014 to hire five more, bringing the total number of John C. Lincoln transition coaches to 14.

The additional coaches make it possible to provide transition services not only to designated Medicare inpatients, but to all frail elderly patients being discharged from both hospitals, regardless of Medicare status or membership in John C. Lincoln’s Accountable Care Organization.

“But our primary goal is not to chase statistics,” says Transition Coach Program medical director John Lees, DO. “It is to reduce readmissions by helping at risk patients.

“Our first goal is to take care of discharged patients the way their own children or grandchildren would take care of them . . . to love on them and make sure their food, safety, medication, follow-up doctor visits, transportation or other everyday needs get taken care of, so their health is maintained, so they don’t relapse for preventable reasons,” Dr. Lees said. “Our goal is their optimal health.”

A key component, Dr. Lees said, is hiring transition coaches from the pool of trained military medics and corpsmen returning from active service in the Mideast. In spite of their rigorous training and experience, these soldiers are considered unqualified for most civilian health care positions. John C. Lincoln is providing employment relevant to the work they did in the field while harnessing their abilities, knowledge and disciplined initiative to address the needs of discharged Medicare patients.

Using the strategic, creative and responsive skills learned during military service, the transition coaches work with patients in the following major areas:

·         Medication self management – Making sure patients have access to pharmacies, can afford to their prescriptions, know how and when to take their medications, and understand the drugs’ purpose and potential side effects.
·         Physician follow-up – Making sure the patients know when to see primary or specialty physicians for follow-up care, that such visits are scheduled and that the patient has needed transportation.
·         Patient-centered health records – Teaching the patient to use a personal health record with a computer or smart phone to facilitate communication and continuity of care.
·         Nutrition and home safety – Making sure the patient and pets have adequate healthy food so that malnutrition doesn’t impair recovery; checking the home for hazards that can lead to falls or other injuries.
·         Red flags – Making sure the patient recognizes symptoms that indicate his or her condition is worsening and knows what to do to get help.

These services, none of which involve medical care, are essential to the preservation of patients’ health, Dr. Lees said.

“Many have asked why our program is so much more successful than other hospitals’ efforts to maintain the health of their discharged Medicare patients,” Dr. Lees said. “We’re still evaluating our experience to find out why.”

However, some factors the transition team believes are crucial to their success include:

·         Veterans relate well with patients.
·         Veterans are geared to recognize and solve problems, traditionally or out-of-the-box, creatively and immediately.
·         Transition coaches with access to John C. Lincoln’s electronic health records system don’t have to rely on their patients for health history, medication review or other information, because all that can be accessed on a computer, laptop, tablet, iPhone or Android. Follow-up doctor appointments or prescription refills can be made expediently online.

“We are enthusiastic about our initial success,” Dr. Lees said, “and we hope that our program, the national winner of the 2012 White House Healthcare Policy Challenge, will be recognized as a best practice that will become a model for the nation.

“There are currently more than 20,000 military combat medics and corpsmen returning from Iraq and Afghanistan who need jobs and who could help preserve the health of Medicare patients released from hospitals across America,” Dr. Lees said. “Wouldn’t it be ideal if they could do what our transition coaches are doing?”