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Health Care in America: What Can We Do to Bend the Curve?

Successful ACOs like ours are part of the solution

UH Clinical Update - October 2017

By Cliff Megerian, MD, President, University Hospitals Physician Services

There are hundreds of issues on which our legislators disagree when it comes to health care. But there is one fact beyond argument: We spend twice the amount on health care, as a portion of our Gross Domestic Product, compared to our closest competitor among developed countries.

Nearly every study indicates that health care expenditures will continue to rise, and possibly approach 25 percent of the GDP by 2025. That growth, in the opinion of nonpartisan economists, is unsustainable if as a country we are also spending on education, infrastructure, defense, social services and other entitlement programs.

There is, of course, some good news about health care in the U.S. We have lowered the mortality rate for cancer by far more than other countries. And we lead the world in research and in cancer treatment. However, in almost every other category where we outspend other countries, we do not have good results. The U.S. is ranked 38th in the world when it comes to the efficiency of our health care system, and we have a greater prevalence of chronic conditions than other developed nations.

This reality translates to a mandate for us to embrace population health.

At UH, this takes the form of our Accountable Care Organization (ACO). This care model is helping us prevent and manage the diseases that drive up health care costs and impair our patients’ quality of life. UH has the 5th largest ACO in the U.S., which means that in a global sense, we manage the lives of 350,000 patients. And every year, our physicians are rewarded financially on the positive results and overall health that patients in our ACO achieve.

Our UH ACO allows for better communication and more efficiency between you and your patients by coordinating appointments and identifying medical issues even before the patient arrives at the your office. The ACO’s patient navigators, nurses, social workers, pharmacists, dietitians and tobacco cessation specialists work with patients and physician offices to coordinate needed care. Physicians receive up-to-date information on patients’ immunization status, previous diagnoses and needed screening tests. For their part, patients receive help from a patient navigator in making follow-up appointments, obtaining a referral to a dietitian or pharmacist, getting medical equipment and coordinating social services.

When a patient is hospitalized or seen in the emergency room, it’s our ACO Nurse Care Coordinators who contact the patient within 48 hours of discharge and make sure that he or she has the appropriate prescriptions, follow-up appointments and medical equipment. The nurse also contacts primary care providers to let them know about a patient’s ER treatment or admission, so the PCP can see the patient soon after discharge.

What makes this work is the use of data analytics. The ACO receives extensive claims and utilization data from all of the payers in each of the different ACO programs. This allows the ACO to identify high-risk/high-utilizing patients and provide information to you, so that you can intervene before new and more dangerous medical problems occur.

Our ACO also works closely with the IT and EMR teams to improve workflow for you day-to-day. Physicians have been burdened with ever-increasing regulatory and documentation metrics and requirements. The ACO addresses that with streamlined templates, order sets and reminders to guide you quickly through those requirements, allowing you to spend more quality time with your patients.

The end result of this effort? UH physicians have achieved high levels of quality measurement, often ranking in the 90th percentile across national standards. At the same time, the cost of the medical care provided through our UH ACO has consistently decreased in comparison to market trends and in terms of absolute dollars. With 55,000 Medicare lives, for example, we reduced costs 2 percent every year since 2012. The lessons we’ve learned are now being applied to all patients within our UH health system.

That’s why we as physicians and as a health care organization must continue to embrace population health. Every patient who is efficiently managed by our ACO offers a mechanism for you to be rewarded for your hard work and for us to bend the health care cost curve. It’s the right thing to do, it’s effective, and it can help keep that upward cost line from moving ever higher.