Last year's top shared-savings performer in Medicare's first two-sided risk model for accountable care organizations is developing a medical-services delivery strategy that can be applied nationwide.
A shared-savings care delivery model that precipitates declining inpatient revenues in the shift from fee-for-service is the stuff of nightmares for most hospital leaders. But Phoenix-based Banner Health is living the value-based dream.
"The road is rocky, but we see a clear path to where we are going. We are very confident that not only can Banner get there, but the country as a whole can do this and do this in a sustainable way," says Robert Groves, MD, CMO of Banner Health Network, the health system's Pioneer ACO.
BHN was among the 32 inaugural Pioneer ACO participants in 2012 and outpaced its peers in the program financially last year by a wide margin, according to performance data that the Centers for Medicare & Medicaid Services released last week.
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For the 2015 performance year, BHN kept spending below its Pioneer ACO benchmark by $35.1 million, earning a $24.5 million shared-savings payment. Newton, MA-based Atrius Health posted the second-highest spending-benchmark performance, spending $6.7 million below its Pioneer ACO benchmark. Minneapolis-based Fairview Health Services earned the second-highest shared-savings payment, at $2.6 million.
BHN also posted the fifth-highest Pioneer ACO quality score last year, at 95%.
Enrollment in the Pioneer ACO program has dwindled steadily, however. Last year, a dozen organizations participated; BHN is among nine Pioneer ACOs this year.
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Although three Pioneer ACOs exceeded their spending benchmark last year, Peoria, IL-based OSF Healthcare System is the only organization that owes CMS, with a $1.6 million shared-losses payment due. Pioneer ACO generated more than $37 million in net savings for CMS in 2015.
Pioneer ACO encourages providers to coordinate the entire care continuum, and Banner Health has embraced that vision. "This is a 9,000-square-mile market. It is hard to own everything, and that is true nationally," Groves says.
Banner Health was well-positioned to succeed in Pioneer ACO from its inception largely due to the health system's history of cooperation with independent physicians, says Lisa Stevens Anderson, vice president at Banner Health and CEO of BHN.
"Banner has a history of partnering with independent physicians," she says.
"We have an employed medical group, Banner Medical Group, that has grown quite a bit over the past five years, but it's only been formally in existence for five years. One of the partner organizations that is part of Banner Health Network is called Banner PHO, physician-hospital organization, which has been in existence in the eastern Phoenix metropolitan area for more than 25 years."
Technology-fueled Growth
Since Pioneer ACO was launched in 2012, BHN has achieved year-over-year gains in quality scores and shared-savings payments by establishing new capabilities and deploying proven value-based care strategies, Groves says.
The health system's iCare telemedicine program is a prime example of how investing in new technology is helping BHN manage the frailest patients among the ACO's 60,000 beneficiaries.
"In their homes, we put in specialized tablets that allow instant communication with the healthcare team, including a physician if the patient needs one," Groves says.
"We put in resources that allow patients to track their weight and other key variables depending on their illness, so we get an early warning when things start to go awry."
"We also have applied traditional strategies but done them very well, like case management and care management," he says. "We take the folks who are not as sick as our highest-risk patients and manage the strategies that are likely to keep them at their optimal level of health."
"Finally, we couldn't do this without the full support and engagement of our aligned partners," Groves says.
"That not only includes physicians, but also our post-acute care partners, home care, palliative care and hospice. We are trying to put the whole puzzle together without leaving any of the pieces out."
Christopher Cheney is the CMO editor at HealthLeaders.