Nov 06, 2017
NYC Health + Hospitals announced today that its accountable care organization (ACO), under the national Medicare flagship program, has achieved shared savings for the fourth consecutive year—the only program in the state to achieve such shared savings success. The ACO was eligible for the savings in part because of its outstanding quality performance.
“Our results are important, not just for the success of our health system, but for other health care providers nationwide,” said Stanley Brezenoff, interim president and CEO of NYC Health + Hospitals. “It shows that a public health care system that cares for the most complex patients can achieve the highest standards of performance—that even a public health system with modest resources and multiple transformation efforts underway can still improve care for some of the most complex patients. It can be done. And it should be done.”
The ACO saved the Medicare program $3.59 million for 2016 and returned $1.58 million in shared savings to the public health system. Through enhanced care coordination, the health system was able to prevent unnecessary emergency department visits, avoidable hospitalizations, and other high-cost care for the more than 10,000 Medicare fee-for-service patients who are followed through the program.
Shared savings are awarded only if quality performance measures are high, and NYC Health + Hospitals’ ACO recorded a score of 90 percent, maintaining its record of consistently strong performance. The score reflects a composite of 34 different quality metrics, covering such concerns as 30-day all-cause hospital readmissions and measures reflecting patients’ control of such conditions as hypertension and diabetes. In addition, for the first time, the ACO recorded a perfect score in the “At-Risk Population” domain, reflecting success in caring for patients who may be more likely to experience a hospitalization or the recurrence of a condition, such as depression.
As a result of its consistent success in the Medicare Shared Savings Program, NYC Health + Hospitals is expanding its value-based payment focus beyond Medicare. It has submitted an application to the New York State Department of Health to become a State All Payer ACO, which would change the payment structure for coordinated care for Medicaid fee-for-service patients and privately insured patients as well.
“First, this is great for our patients as they receive better care. Second, being able to achieve shared savings for a single year is not easy and is itself a cause for celebration,” said Ross Wilson, MD, CEO of the Accountable Care Organization and Chief Transformation Officer for NYC Health + Hospitals. “But savings over four consecutive years is truly remarkable, especially given that our performance is measured against benchmarks of our own past performance. Our success in recent years has made our benchmarks increasingly challenging, and yet, through the focused work of countless members of our hard-working team, especially our front-line providers, we have met our goal yet again.”
The federal Medicare Shared Savings Program was created to change the payment structure for the Medicare fee-for-service beneficiary population. It holds participants accountable for the cost and quality of care delivered to a defined patient population over time.