Defending Aurora CMO Dr. Gary Stuck on ACO success

Defending Aurora CMO Dr. Gary Stuck on ACO success

Despite all the challenges patient care organization leaders face in advancing their value-based contracts at a time when healthcare is heavily impacted by the COVID-19 pandemic and policy and payment changes , some integrated health systems are doing well and showing excellent results , including in the Medicare Shared Savings Program (MSSP) sponsored by the Centers for Medicare & Medicaid Services (CMS).

One such health system that is doing well in the MSSP is Advocate Aurora Health, the integrated health system of 27 hospitals headquartered in Downers Grove, Illinois and Milwaukee, Wisconsin, and whose service area encompasses the entire eastern third of the state of Wisconsin and the entire northeast quadrant of the Illinois. Immediately after CMS announced the results of the MSSP on September 6, Aurora Lawyer executives issued a press release noting their results.

The statement began: “The latest data from the Centers for Medicaid and Medicare Services shows that the three care organizations responsible for Advocate Aurora Health saved taxpayers $79.6 million through the Medicare Shared Savings program in 2021, meeting quality of care criteria while reducing costs. ACOs have saved taxpayers a total of $494 million since joining the MSSP in 2012, with the latest results again placing Advocate Aurora among the top performing integrated health systems in the nation. The latest findings come amid the challenges of the ongoing pandemic, as providers have had to work harder to help patients navigate ongoing care.

The leaders of Advocate Aurora don’t like that, “[B]Building on the success of the MSSP, Advocate Aurora Health is one of the few health systems across the country recently accepted into the ACO REACH program, which begins January 1. This program focuses on equity and ensures that high-quality care is provided to communities that traditionally did not have access to it.

“Value-based care is the future of our industry, and our success in this program over the past nine years shows that we are leading the way through the expertise and commitment of our talented physicians and healthcare teams. care,” said Jim, CEO of Aurora Health. Skogsbergh said in a statement contained in the press release. “Most importantly, these results reflect that our patients are receiving safe, high-quality care while improving affordability. Our results put hard numbers to what we know to be true: we help people live well.

ACO providers led the way in encouraging annual wellness visits, which were especially important in helping patients stay up to date with important screenings and manage their chronic conditions, a nationwide challenge during the pandemic. . Additionally, the system used remote monitoring and virtual visits to stay in touch with patients and manage their care, including the use of automated phone calls to help send important reminders.

“I couldn’t be more proud of how our teams rose to the challenge and worked together to improve outcomes for our patients while reducing the total cost of care,” Chief Medical Officer Gary Stuck, DO, said in a statement also published in the press release. “They have put us at the forefront of value-based care, and we are grateful for their work as we remain focused on delivering the best care to those we serve.

The press release further noted that “Advocate Aurora’s three ACOs received $41.6 million from the program, savings that are reinvested in patient care.”

A spokesperson for Advocate Aurora confirmed Healthcare Innovation the specific results of the organization’s three ACOs, as follows:

• Advocate Physician Partners Accountable Care Inc. (98,212 members), Illinois: “As the largest ACO in Illinois, we have saved taxpayers over $56.9 million. This translates to more than $27 million in shared savings – the most in Illinois. We achieved a quality score of 89%. »

• Accountable Care Organization of Aurora (46,648 members), Wisconsin Track 1: As one of Wisconsin’s largest ACOs, we saved taxpayers $12.1 million. This translates into shared savings of $5.9 million. We achieved a quality score of 98.5%. »

• Aurora Accountable Care Organization (21,118 members) Wisconsin Enhanced Track: “We saved taxpayers $10.6 million, one of the best savings rates for a Wisconsin-based ACO. This translates into shared savings of $7.7 million. We achieved a quality score of 97%. »

Shortly after the release of the results of all of the MSSP’s ACOs, including Attorney Aurora’s, Healthcare Innovation Managing Editor Mark Hagland spoke with Gary Stuck, DO, Health System CMO, about the results and near-term future of CMS’s ACO initiative. Below are excerpts from that interview.

As you review the Advocate Aurora ACO results and the overall MSSP results, what are your first thoughts?

Our Illinois ACO is the largest and most successful in Illinois. Some ACOs had no shared savings. We need to invest in our people and our technology. We were early adopters and joined the MSSP when it was created in 20212. We saved federal taxpayers $494 million, or nearly half a billion dollars. We are incredibly proud of it. We know that our doctors, nurses and team members are transforming care for nearly three million people, and we promote high-quality care. And then to have this intense focus on using our resources wisely, at a time when inflation will only make things worse and the cost curve is unsustainable for employers and taxpayers. We have a proven track record of improving the cost of care.

The COVID-19 pandemic has presented leaders in patient care organizations with many challenges. How did you and your colleagues at Advocate Aurora Health overcome them?

Certainly, the pandemic has tested all health systems and ACO, and it was no different for us. I believe our scale has served us very well; it has helped us get safer, better care at a lower cost; we were able to move people and supplies across our geographies. Before the merger, where Advocate was alone in Illinois, we wouldn’t have been able to manage as well as we did after the merger. Patients are still sometimes reluctant to come to the structures. People are just nervous, they’ve pivoted, they’re scared to come, in person. So that means they sometimes don’t get the necessary screenings. So our patient outreach and reassurance work to attract people and tightly manage their conditions – we used remote patient monitoring and used remote tools, to manage patients in new ways and to deliver better care . But you have to invest in these technologies and in patient education.

If you have had nursing shortages, what impact has this had on your work as an ACO?

We were affected, like all organizations. We have certainly experienced staff shortages and are still struggling in some areas. And our labor costs have gone up. And we are not immune to this. But it does require us to be really careful to use our resources wisely, whether it’s facilities or nurses in certain units; it forces us to analyze what we are doing. This is aligned with our ACO work, where we analyze every line item, reduce waste, and engage in remote patient monitoring etc. These are not temporary fixes, we need to be aligned for the future.

One of the things that happened under the previous administration was a certain level of conflict over the benchmarks of the MSSP. Some ACO organizations and associations have come into conflict with CMS administrator Seema Verma over the structure of the repositories, arguing that the way the repositories were structured could lead to a large number of vendors leaving the MSSP over time. time. Do you have any thoughts on that?

Without going into the details of the political arena there, there is still a general feeling that we need to continue to refine the shared savings program from Medicare and others. And we announced that we were leaving the BPCI program at the end of the year. We still think it served its purpose. We learned a lot about transforming care through our participation in the package program. We saw this as an opening to transformation. And the federal government said they wanted to infuse health equity into the system, so we applied to the ACO REACH program. You stay at the MSSP, but some patients…we would participate in both and would like to partner to help transform this program. We want to be at the forefront of improving care for our patients and reducing the cost of care; we think this is a great opportunity for partnership.

What have been the biggest challenges of this ACO work over the past decade and how have you overcome them?

You must experience transformative programs; you must continually evaluate what you are doing, to create value. We’ve made mistakes over the years and had to pivot, so we’ve had to be brave and keep transforming and thinking about what’s next; and then there are market forces, then pandemic forces, and continue to be nimble. So learn as a learning health system and keep pivoting, but stay focused on the mission and keep patients first. When we put the patient first, we always win.

Is it part of the point of not being afraid to make mistakes? Some ACOs and other leaders have described it as willing to “fail fast” and work as a learning organization.

Yes, the organizational element of learning is important. Additionally, we have a fair culture, where we share our mistakes internally and try to learn from them, and we constantly try to align our programs. And we use health system learning tools, in areas related to infection – improving sepsis care, infection rates. Over the past three years, we have taken great pride in being a learning system.

Can you talk about the role of data and analytics in your success?

We use data tools to track our patients, and we know this is the future of using data and AI to predict care for our patients, to prevent readmissions for patients with CHF and COPD, etc. We constantly re-evaluate these data tools. , and we really think that’s the next step for us, in terms of tracking patient journeys.

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