For all the challenges facing the leaders of patient care organizations in moving forward in their value-based contracting in a time in healthcare strongly affected by the COVID-19 pandemic and policy and payment changes, some integrated health systems are doing well and showing excellent results, including in the Medicare Shared Savings Program (MSSP) sponsored by the Centers for Medicare & Medicaid Services (CMS).
One of those health systems that has been doing well in the MSSP is Advocate Aurora Health, the 27-hospital integrated health system dually headquartered in Downers Grove, Illinois, and Milwaukee, Wisconsin, and whose service area encompasses all of the eastern third of the state of Wisconsin and the entire northeast quadrant of Illinois. Immediately after CMS announced MSSP results on September 6, Advocate Aurora leaders issued a press release noting their results.
The release began, “The latest data from the Centers for Medicaid and Medicare Services show that Advocate Aurora Health’s three accountable care organizations have saved taxpayers $79.6 million through the Medicare Shared Savings Program in 2021, meeting benchmarks for quality care while lowering costs. The ACOs have saved taxpayers a total of $494 million since entering MSSP in 2012, with the latest results once again putting Advocate Aurora among the top-performing integrated health systems in the country. The latest results come amid the challenges of the ongoing pandemic, when providers have had to work harder to help patients keep up with ongoing care.”
The Advocate Aurora leaders not that, “[B]uilding on success in MSSP, Advocate Aurora Health is one of just a handful of health systems across the country recently accepted into the ACO REACH program, which starts Jan. 1. This program focuses on equity and ensuring high-quality care is delivered to communities that traditionally have lacked access.”
“Value-based care is the future of our industry, and our success in this program over the last nine years shows that we are leading the way thanks to the expertise and commitment of our talented physicians and care teams,” Advocate Aurora Health CEO Jim Skogsbergh said in a statement contained in the press release. “Most importantly, these results reflect that our patients are receiving safe, high-quality care while advancing affordability. Our results put hard numbers on what we know to be true: We help people live well.”
ACO providers led the way by encouraging annual wellness visits, which were especially important for helping patients stay current with important screenings and manage their chronic diseases, a challenge nationwide during the pandemic. In addition, the system used remote monitoring and virtual visits to stay in touch with patients and manage their care, including the use of automatic phone calls to help send important reminders.
“I couldn’t be prouder of how our teams have stepped up to the challenge and worked together to improve outcomes for our patients while lowering the total cost of care,” Chief Medical Officer Gary Stuck, D.O., in a statement also carried in the press release. “They have put us on the leading edge of value-based care, and we’re thankful for their work as we remain focused on delivering the best care for those we serve.”
The press release further noted that “Advocate Aurora's three ACOs combined received $41.6 million back from the program, savings that are re-invested in patient care.”
An Advocate Aurora spokesperson confirmed to Healthcare Innovation the specific results from the organization’s three ACOs, as follows:
• Advocate Physician Partners Accountable Care Inc. (98,212 members ), Illinois: “As the largest ACO in Illinois, we saved taxpayers more than $56.9 million. This results in more than $27 million in shared savings – the most in Illinois. We achieved an 89-percent quality score.”
• Accountable Care Organization of Aurora (46,648 members), Wisconsin Track 1: As one of the largest ACOs in Wisconsin, we saved taxpayers $12.1 million. This results in $5.9 million in shared savings. We achieved a 98.5-percent quality score.”
• Aurora Accountable Care Organization (21,118 members) Wisconsin Enhanced Track: “We saved taxpayers $10.6 million, one of the top savings rates for a Wisconsin-based ACO. This results in $7.7 million in shared savings. We achieved a 97% quality score.”
Shortly after the results for all the MSSP ACOs, including Advocate Aurora’s, were published, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Gary Stuck, D.O., the health system’s CMO, about the results and the near-term future of CMS’s ACO initiative. Below are excerpts from that interview.
When you look at the results for Advocate Aurora’s ACOs, and the overall results in the MSSP, what are your initial thoughts?
Our Illinois ACO is the largest, and the most successful in Illinois. Some ACOs had zero shared savings. It takes investment in our people and technology. We were early adopters, and we joined the MSSP at its inception in 20212. We’ve saved federal taxpayers $494 million, nearly a half-billion dollars. We’re incredibly proud of that. We know that our physicians, nurses, team members, are transforming care for nearly three million people, and we’re promoting high-quality care. And then to have this intense focus of using our resources wisely, at a time when inflation’s only going to make that worse, and the cost curve is not sustainable for employers and taxpayers. We have a proven track record for improving the cost of care.
The COVID-19 pandemic presented patient care organization leaders with many challenges. How have you and your colleagues at Advocate Aurora Health overcome them?
Certainly, the pandemic challenged all health systems and ACOs, and that was no different for us. I believe that our scale served us very well; it helped us achieve safer, better care at a lower cost; we were able to move people and supplies across our geographies. Pre-merger, where Advocate was by itself in Illinois, we wouldn’t have been able to manage as well as we did post-merger. Patients are still sometimes reluctant to come to facilities. Folks are just nervous, they’ve pivoted, they’re afraid of coming in, in person. So that means they’re not getting the needed screenings sometimes. So our work of providing patient outreach and reassurance to pull folks in and tightly manage their conditions—we’ve employed remote patient monitoring and used remote tools, to manage patients in new ways, and to provide better care. But you have to invest in those technologies and in patient outreach.
If you had nurse staffing shortages, how did that impact your work as an ACO?
We were affected, like every organization. We certainly have had staffing shortages, and are still challenged in certain areas. And our labor costs have gone up. And we’re not immune to that. But that gets to us being really thoughtful about using our resources wisely, whether that’s facilities, or nurses in certain units; it requires us to analyze what we’re doing. It’s aligned with our ACO work, where we’re analyzing every line item, and cutting waste, and engaging in remote patient monitoring, etc. These are not temporary fixes, we have to be aligned for the future.
One of the things that happened under the previous administration was some level of conflict over the benchmarks in the MSSP. Some ACO organizations and associations became involved in conflict with CMS Administrator Seema Verma over the benchmarks structure, arguing that the way the benchmarks were structured might lead to large numbers of providers leaving the MSSP over time. Do you have any thoughts on that?
Without getting into the specifics of the political arena there, there’s always a general feeling that we need to keep refining the Medicare Shared Savings Program and others. And we’ve announced we’re exiting the BPCI program at the end of the year. We still feel it served its purpose. We learned a lot about transforming care during our bundles program participation. We saw that as an opening to transformation. And the federal government has said they want to infuse health equity into the system, and so we’ve applied to the ACO REACH program. You stay in MSSP, but certain patients… we would participate in both, and would love to partner to help transform that program. We want to be at the forefront of improving care for our patients, and lowering the cost of care; we think this is a great opportunity to partner.
What have been the biggest challenges in this ACO work over the past decade, and how have you overcome them?
You have to experiment in transformative programs; you have to continually evaluate what you’re doing, to create value. We’ve made mistakes over the years and have had to pivot, so we’ve had to be courageous and continue to transform and think about what’s next; and then there are market forces, and then pandemic forces, and continue to be nimble. So learn as a learning health system, and continue to pivot, but stay focused on mission and keep patients first. When we put the patient first, we always win.
Is part of the point to not to be afraid of making mistakes? Some ACO and other leaders have described it as being willing to “fail forward fast,” and to work forward as a learning organization.
Yes, the learning organization element is important. What’s more, we have a just culture, where we share our mistakes internally and try to learn from them, and we’re constantly trying to align our programs. And we use learning health system tools, in areas around infection—improving sepsis care, infection rates. We’re very proud over the last three years over being a learning system.
Can you speak to the role of data and analytics in your success?
We’ve been using some data tools to track our patients, and we know that that’s the future of using data and AI to predict care for our patients, to prevent readmissions for CHF and COPD patients, etc. We are constantly reevaluating those data tools, and we really think that that’s what’s next for us, in terms of tracking patient journeys.
