Accountable Care Benefits Patients, Providers, and Broward Communities

How can this be? In simple terms, costs are too high and outcomes too poor. This reflects a failed, decades-old mindset that focuses on treating illness instead of providing whole-person care. We pay for services rendered instead of actual health outcomes, an approach that’s not only harmful, but unsustainable.

Changing the Paradigm

“Accountable care,” a strategic part of the value-based care model, came about to re-orient the U.S. healthcare delivery system from spending on services provided irrespective of outcomes (“fee-for-service”) toward rewarding providers for higher quality care and better patient outcomes. Inherent in the newer payment model is a risk-reward where providers (hospitals, physician groups, etc.) assume a degree of financial risk and are rewarded with a share of the savings earned by improving recoveries, preventing complications, and keeping patients healthy.

It’s a triple-win.

• Patients get better outcomes.
• Providers are able to use evidence-based care more efficiently.
• Our communities get healthier citizens at a lower cost.

Unlike an insurance company using gatekeepers, prior authorization, and other mechanisms to delay/deny care and payment, this approach incentivizes improved clinical treatment when it delivers results.

Memorial Healthcare System began its accountable care journey over 10 years ago because we believed providers should be held accountable for providing optimal results. Today, we’re proud to report more than 300,000 of the South Florida residents we serve are in some form of commercial, Medicare, or Medicaid accountable-care model.

Lessons Learned

We have learned a lot in the last decade. First was the importance of overcoming the false notion that cost savings need come at the expense of quality care. On the contrary, they come as the result of better care.

In 2021, Memorial’s Accountable Care Organization (ACO) saved five times more than all other health-system organized ACOs, the best result nationwide. It did so by coordinating care, avoiding unnecessary treatments, and reducing harmful complications. Savings came through proactive measures, including remote patient monitoring. For example, through the use and monitoring of at-home devices that securely transmit health-related data, we’re able to adjust medication to address an issue a patient may not know is problematic. It’s resulted in a:

• 23% reduction in avoidable emergency department visits,
• 16% reduction in hospital readmissions, and
• 38% increase in the number of services delivered by primary care.

Chronic conditions are being managed, preventing more serious issues, which save lives and money.

We’ve also learned the primary driver of these improvements and savings is a care delivery model that’s based on the whole person. This entails programs and evidence-based interventions designed to sustainably improve the health and well-being of patients across the continuum of care and throughout the community.

Preventive services, improved support to help individuals better self-manage their conditions, safer transitions from hospitals to post-acute facilities, integrated remote monitoring, and a streamlined navigation of our healthcare system all play an important role.

Memorial is also critically sensitive to Social Determinants of Health (SDOH), understanding that 80% of what impacts a person’s health are non-clinical factors of a socio-economic, behavioral, and environmental nature. Today, SDOH screening and impact management are standard practice throughout our system and, when assistance is required, our SDOH Hub and community partners ensure there are services provided to meet patient needs.

The Future

Despite its many advantages, accountable care is still a work-in-progress. The current federal rules don’t always promote, and sometimes outright disincentivize, what the system is trying to achieve. For instance, if a Medicare patient wants to benefit from the cost savings and improved outcomes our remote monitoring program delivers, he or she must pay a deductible or co-pay. Patients who decline to participate often cite the financial burden as a primary factor in the decision.The tide, however, is turning. Medicare spending, which for decades had continued to increase, is now essentially flat, with spending per beneficiary nearly leveling off in the past decade. This is welcome news, particularly given a rapidly aging population and the U.S. national debt.

But it’s not a mystery how it happened, with accountable care deserving the lion’s share of credit for re-shaping how, and by how much, better outcomes can be delivered at lower costs. That’s been the case in our Broward communities, something we’re especially proud to have played a significant role in making happen.

Matt Muhart is chief strategy officer and Monica Puga, RN, MSN, is chief nursing executive at Memorial Healthcare System.