According to numerous studies, South Florida is among the most expensive Medicare markets in the United States today. Miami-Dade County alone sees the highest unadjusted health care spending per capita by nearly double the national average. Orange Accountable Care of South Florida was established in 2014 with the mission of increasing quality of care and improving patient experience, while decreasing unnecessary medical spending in the tri-county area.
As an Accountable Care Organization (ACO) participating in the Medicare Shared Savings Program in Florida, Orange serves a broad population with complex health care needs. “South Florida’s high per capita expenditure means there is great opportunity for significant improvements in both care and costs,” mentioned Orange President and CEO Lissette Exposito, RN, BSN, MHSA. “In starting Orange, I wanted to build a company that would have a long-lasting impact on the health of South Floridians."Research indicates that of the nearly forty million emergency room visits made by patients in the United States every year, only eight percent of those visits are for immediate or emergent conditions. These unnecessary ER visits can lead to avoidable hospitalizations. Orange has successfully reduced the number of hospitalizations in South Florida by working closely with its primary care physicians to increase patient access to their doctor. Orange has also increased physician and patient engagement in preventative care. “Our analytics platform enables physicians to take a 360-degree view of their patients’ patterns of health care utilization. This allows for stratification and enhanced planning for prevention, placing the PCP back at the forefront of their patients’ care.” Through its Transitional Care Management program, Orange also helps navigate patients back to their PCP after hospital and skilled nursing facility discharges.
The Orange model provides direct incentives designed to result in the right health care outcomes, both clinically and financially. By moving away from traditional fee-for-service to value-based approaches, Orange frees physicians from accustomed inefficiencies, allowing them to concentrate on what they do best: treating patients. Physicians as members of the ACO also benefit from financial reimbursements when specific quality and cost-saving goals are met. “Practices that meet high quality standards while reducing unnecessary health care costs will collect substantial bonuses," said Exposito, adding that this enables doctors to remain independent in their practices. Additionally, Orange reimburses physicians before recouping all management expenses, a quality Exposito emphasizes is unique to the organization.
"With the onset of the Medicare Access and CHIP Reauthorization Act (MACRA), physicians need to be prepared to face all of the mounting requirements needed to meet quality standards and value-based financial incentives," Exposito explained. "The ACO is poised to be the ideal platform to assist physicians in meeting these demands."
Patients benefit from more personalized, one-on-one care experience, which includes assigned Orange care managers who work directly with the physicians. “We are a physician-led, patient-centered ACO and that means that we are very hands-on,” said Exposito. “In the past, doctors spent most of their time caring for really sick patients, while well patients were sometimes overlooked. Now no patient is left behind. This is one of our greatest strengths,” continued Exposito. “Our three-hundred-and-ninety-seven ACO providers all share the same goal – to care for patients in a more comprehensive way, focusing on quality versus volume.”
In addition to Orange’s care management platform, the ACO also works in conjunction with the University of Miami School of Nursing and Health Studies to deploy nurse practitioners to visit high-risk patients in their homes. “I believe that no other ACO has clinical programs like ours as these were designed by our lead physicians with the patients’ current and future states in mind," said Exposito. "Our programs reflect a direct collaboration between our ACO primaries, our patients and caregivers, their specialists, and the community. This is quality health care as it should be."
