Thursday, July 9, 2015

Saving Medicare and Taxpayers (at least) $16,440,000 Annually While Improving Health and Care and Adding Joy

We formed the Greater Baltimore Health Alliance (GBHA) in 2012 so that our employed and private practicing physicians could participate in programs designed to help us reach our quadruple aim of better health outcomes and better care experience with less waste of resources and more joy for those providing the care. The first program with which GBHA contracted was the Medicare Shared Savings Program that came into being as part of the Affordable Care Act.

So how are we doing at making Medicare beneficiaries healthier and happier with their care? Are we saving any money? Are those individuals taking care of our patients any happier?

We now have more than two years worth of data and the results are pretty impressive. We serve roughly 12,000 Medicare beneficiaries in this program. In 2012, just before we started the program, Medicare costs for our patients were averaging $12,653 annually. In the first quarter of 2015, GBHA Medicare patients had an average annual cost of $11,283! Other accountable care organizations have also done well, but they have seen the average cost per beneficiary go up by approximately 1.4 percent (see the figure below).

This is a phenomenal accomplishment! Nationally, in the four decades from 1970 to 2010, Medicare spending per beneficiary grew at approximately the rate of growth of the Gross Domestic Product plus 2.7 percentage points annually, or in the range of 5.7 percent. . Not only are we not seeing the cost per beneficiary increase, but GBHA has actually reduced it by 10.8 percent over the past two years. With a $1,370 decrease per beneficiary and 12,000 beneficiaries served, we saved $16,440,000! That is not counting the projected five percent annual increase that was projected.
We have done this by reducing emergency department visits by 12 percent (see below),

and overall admissions to the hospital by 26 percent!

Our Patient Centered Medical Homes (PCMH) are doing an excellent job of improving the health of their patients. Our physician-led care teams are holding themselves accountable for delivering evidence-based care to everyone-not just Medicare beneficiaries. These care teams receive monthly “scorecards” to track their progress, and meet regularly to see how their patients are doing and decide what they could do next to move closer to perfection. GBHA is one of the few healthcare organizations in Maryland that is measuring its performance on the “diabetes composite score.”  The score is made up of tracking five items that, if present, have been shown to increase the health of diabetic patients (Hemoglobin A1c in range, blood pressure in range, cholesterol in range, non-smoking, and utilizing a daily aspirin or blood thinner). GBHA is now in the top 15 percent of organizations nationally in diabetes care, and we are working hard to see that all of our patients have evidence-based screening tests completed. For example, our care teams are working on “tests of change” to see that everyone who should have had a colonoscopy performance-based on demographics such as age, medical history and other factors – has had one.

Additionally, the patient satisfaction scores for patients of our employed physicians have never been higher.

What about the joy of those providing the care? This is the hardest thing to measure, but anecdotally, the primary care physicians are happier that they now have the support of a team to get the work done.  We are no longer judging our primary care physicians solely on the number of patients they have seen, but are now supporting them in their quest for value-driven care.

We have many more metrics of health outcomes and care engagement that show improvement and I am so grateful to everyone on the GBMC team that is driving us closer to our vision.

Our community is taking notice. We are achieving better health and better care at lower cost and our team is finding more joy in its work. We still have more improvement work to do but I am so proud of all that has been accomplished so far.  Thank you!


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