Achieving financial sustainability in an accountable care organization is not a destination, but a journey. Whether you’re in an existing ACO or are considering joining one, you don’t have to reinvent the wheel or embark on your own to create new revenue and succeed at population health management. After working with more than 14,000 clinicians nationwide, we’ve identified what hospitals need to achieve their goals.
Our proven methodology and expertise have been adopted by Medicare providers across the country as they transition from traditional fee-for-service to fee-for-value reimbursement model. Our clients are improving their workflows, lowering costs and reducing burnout -- key factors to sustainable operations and profitability.
Caravan Health recently spoke with Dr. Kelly McGrath, Chief Medical Officer at Clearwater Valley Hospital and Clinics, about how participating in a Caravan Health ACO has helped improve their financial sustainability.
Caravan Health: What were some of the financial challenges your organization faced before joining the ACO?
Dr. McGrath: One of the biggest challenges was access to data. Many health care providers don't know the cost of the care they are delivering. Our hospital, like almost every organization, was almost completely blind to that. To go forward in value-based health care and really improve the quality of care while improving cost, you have to know what the costs are.
After joining an ACO, we have learned what our costs are and where the savings opportunities are, so we no longer have to speculate. Before joining the ACO, we had taken some steps with initiatives of chronic care management (CCM) and annual wellness visits (AWVs), but we didn’t have a compelling drive to go organization-wide; consequently, our success rate wasn’t that high. Caravan Health offered a practical model to take those elements across the organization. This was helpful for us in driving our quality scores up. As an organization we’ve been really focused on quality of care for more than a decade, but we needed to bump it up to the next level.
Caravan Health: What parts of the Caravan Health methodology have been most helpful?
Dr. McGrath: Caravan Health was most helpful in putting forth a step-by-step plan for us to follow. It seemed so simple: set goals for AWVs, CCM, advanced care planning, etc. Initially we found ourselves asking, “Really? This is it?” But it was instrumental to our journey. Once we got on the path, we saw how it was driving better care and lowering costs.
Caravan Health: Have your providers and hospital leaders been able to see positive financial results from ACO participation?
Dr. McGrath: Because we've been doing a really successful job in the fundamentals of population health management, we have been really successful in improving the care and driving down hospitalizations. Historically, hospital stays have been a primary means of support for rural health care systems. Our provider group took the time to outline how the volume-based world is not sustainable in rural health care. As we talked about the process measures that we planned to take, I continued to remind them that this is a way to bring more compensation to the hospital which directly and measurably helps the bottom line of the organization. We also went in with a plan to make up for all the admissions that would be prevented. It’s not simply creating a new revenue source, but it's a revenue source that drives value. Once everyone understood the how and why of the model, we got past that fear and reached the tipping point. Within the first 30 days the critical mass was on board.
Caravan Health: How have patients reacted to the changes?
Dr. McGrath: I was really surprised that the patients really got the value of the AWV. I anticipated it to be much harder to convince them of the advantages. We mostly do our annual wellness visit as dual visits, which gives patients that feel of added value because we're addressing several things in one visit. Patients understood it was a means to give them better care.
Caravan Health: What specific actions or efforts were most effective for the success you've achieved so far?
Dr. McGrath: As a physician, much of the preparation work has been done before I walk through the door for a visit. This lets me focus time on reinforcing wellness plans and providing additional education.
Meeting routinely as provider group is also beneficial. We can provide ongoing feedback on success or lack thereof to keep us on track. Our meetings have standing agenda items which include reporting on our value-based care, CCM and AWV goals. Because there’s a lag in data, we also found it helpful to keep everyone up to speed by sharing the information we gather internally. We took the goal of 80% AWV that Caravan Health set seriously. Although we didn't quite achieve it, we came close at 74%. One group heard 80%, and they just accepted that goal and went for it in earnest. They're a competitive group, so that's good.
Caravan Health: How does care transformation address provider burnout?
Dr. McGrath: We've been very focused as an organization on provider burnout for more than three years. In addition to reporting quality metrics like diabetic care, our group asked the administration, which includes me, to include physician burnout as a quality metric to report to the board. We use the Wellness Index, and report quarterly on physician burnout. A few years ago, we were at 60% which is on par with published rates of 50-60% in primary care throughout the country. As we were increasing our AWV rate, our burnout scores consistently dropped. In our most recent quarter’s report, we were at 7%. I can share from personal experience that I feel less burden, and it's been useful to have the full care team more involved.
Caravan Health: How does value-based care influence the operations and care delivery in the rural critical access hospital setting?
Dr. McGrath: We need to sustain the providers we have and recruit new ones. Rural medicine used to be pretty brutal. Physicians really had to be willing to make an immense personal sacrifice. Starting about five to 10 years ago our organization realized there was no way we were going to get anybody else to come and help us if we stayed with that model. We have focused on making sustainability part of our recruitment strategy. Prospective staff are typically quite focused on balance, lifestyle and the team that they're going to be on. We show everyone who is interested in working here the burnout scores, and we talk about balance, team-based care, and integrated behavioral health that’s included within the team-based care approach.
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