'Value-Based Care Can't Be a Side Hustle' — How Advocate Health Saved $135M

Preventative care, robust technology, and dedicated clinicians are key ingredients in the recipe for successful value-based care.

Advocate Health generated $135.7 million in savings in 2023 from two top federal programs. The health system, the third largest non-profit in the country, realized these savings through its affiliated accountable care organizations (ACOs).

By participating in the Medicare Shared Savings Program (MSSP), which generated $128.6 million in savings, and ACO REACH, a health equity program that generated $7.1 million. Advocate Health reached almost $898.1 million in savings through CMS programs since 2012.

Key tactics to achieving these savings include robust care management, clinical programs that help support patients who are managing chronic conditions, automated technology that keeps patients engaged after a hospital stay to help reduce readmissions and ER visits, and additional care transition services.

Finding success in value-based care is not always easy, but high patient engagement is a must, says Advocate Health's Chief Population Health Officer, Don Calcagno. Automated follow-up is essential, giving patients a nudge to take control and fully understand their health journey.

Advocate Health uses tailored, automated technology to follow-up with patients after their visits.

"A patient's role is critical to success in value-based care," Calcagno says, adding that health literacy is, unsurprisingly, a challenge. Care teams must take charge to help patients understand the complexities so they are in the best position to navigate their health journey.

A dedicated team is a blessing, he says.

Building a dedicated team means having clinicians involved in every step of the care process. Calcagno says this doesn't just mean talking about numbers, but identifying how many care opportunities were achieved,  and where the gaps still lie.

"Alternative reimbursement models like CMS' MSSP and CMMI's REACH are complex and involve a lot of numbers,"  he says. "We never lose sight of the fact that these numbers represent real people with real health care needs."

While Advocate Health also focuses on preventative care, the most critical factor to success in value-based care is network culture.

"The network of providers needs to be aligned to the objectives of the value-based care model," Calcagno says.

Once there's that alignment, he says, people, processes and technology can come together to make the role of the clinician easier, unburdened by administrative minutia.

"From a clinical perspective, we need to focus on preventative care so [that] we catch disease early, chronic disease management so [that] we get the patients chronic disease under control, and episodic care so [that] when acute care is necessary it is efficient and effective," he says.

Technology is also critical for this type of care model to succeed, whether it's EMRs, automation and AI, or data analytics.

"The challenge is to understand what is vapor-ware vs. real technology that can immediately make an impact," he says.

Calcagno says the best approach blends human and artificial intelligence.

"Table stakes for value-based care is having a robust data intelligence platform that allows you to integrate data from disparate systems to create a longitudinal patient record that can drive reporting, actionable intelligence and advanced analytics," he says.

While rewarding providers through financial incentives plays a role, it should not be the driver, he says. That's how health systems will improve quality.

Even though Advocate has been on the VBC train since the early 2000's, it hasn't always been easy or straightforward. The journey has come with mistakes, lessons and stumbles that have allowed the system to grow.

Expect that the process will be iterative, Calcagno says.

"A consistent commitment to transforming health care, not pivoting when times get tough, is key to getting buy-in across your network," he says.

For other health systems looking to emulate what Advocate has achieved, Calcagno says  "value-based care can't be a side-hustle."

Health systems can run some simple tests such as budgeting the savings from alternative models, investing in infrastructure, and participating in CMMI programs to get a handle on where a VBC model could go.

The bottom line is commitment, he says.

"Your organization needs to be comfortable failing from time-to-time," he says. "Not everything you do is going to work, but that is part of the exciting journey of improving the healthcare ecosystem."