New health practice leading to better patient care?
BY MONIFA THOMAS Staff Reporter mjthomas@suntimes.com August 3, 2012 9:48PM
Gwlie Lloyd, Care Manger_RN with patient Derrick Storey and his wife, Laetitia Storey (right) at Advocate Health Care, 2545 S. Martin Luther King Dr., Tuesday, July 31, 2012. | John H. White~Sun-Times
Updated: September 6, 2012 6:22AM
Derrick and Laetitia Storey are giving a big thumbs-up to a program featured in ObamaCare.
The couple, of Hyde Park, enrolled in a so-called accountable care organization, or ACO, through Advocate Health Care. When Derrick, 54, needed follow-up care after a motorcycle accident that punctured his lung, broke a few ribs and caused head trauma in June, he said he saw a big difference in his treatment as compared to when he went to Advocate hospitals or clinics before.
“It’s been a totally different program,” Laetitia Storey said.
He had a care manager whom he could call whenever he had a question and even had a nurse who came to his home — saving him a trip to the emergency room — after a catheter in his arm began bleeding.
“Advocate was there,” his wife said. “And I have to say that in a resounding voice they were there, and it was not a care that I was used to.”
Advocate, too, is singing the praises of the program after its first year in operation.
In January, Advocate, which includes 10 acute care hospitals and more than 250 other sites, created AdvocateCare, one of the nation’s first and largest ACOs. There now are 380,000 patients insured by Blue Cross Blue Shield of Illinois enrolled in the program.
Advocate says the new health-care practice has resulted in lower readmission rates, which many groups and federal health authorities consider an indication of better patient care.
Achieving lower hospital re-admisssion rates is one of the key goals of ACOs, which are now being heavily promoted by the Affordable Care Act signed into law two years ago by President Barack Obama.
There’s no one model of ACOs, but they can consist of doctors, hospitals, insurance companies and pharmacists. Hospitals and physicians who participate in an ACO are paid in the traditional fee-for-service model. But results are compared to the market trend to determine if there were any savings. The savings are then shared between the ACO and the insurance company.
The goal is to reward organizations for lowering overall costs to patients while improving quality of care.
While Advocate declined to provide specific financial data that would have shed light on whether the new model had resulted in cost savings, Advocate did release re-admission rates for its first year, which suggests that patients are receiving better care.
That data shows that patient with chronic illnesses like diabetes or congestive heart failure who were part of the AdvocateCare program with Blue Cross Blue Shield and had the benefit of a transition coach— who follows their care upon discharge from the hospital— saw a 26 percent reduction in readmission rates compared to patients who did not have a transition coach.
Hospital readmission rates for AdvocateCare patients who were sent to nursing facilities were also lower than the national average, 13.6 percent for AdvocateCare versus 20 percent nationally.
Advocate said the findings reflect the changes Advocate made in preparation for becoming an ACO, such as expanding their electronic medical record system and adding more than 70 care managers who help keep patients out of hospitals by reminding them to take their medications and troubleshooting logistical issues.
“Our keen focus on care coordination, prevention, early detection and education is ensuring our patients receive the right care, at the right time and at the right place,” said Dr. Lee Sacks, executive vice president and chief medical officer of Advocate Health Care.
But some critics of ACOs have expressed concern about adopting the untested model on a large scale, in part because it is expensive and complicated to initially put into place.
Ken Anderson, chief medical quality officer at NorthShore University HealthSystem, said there are weak spots of ACOs that remain unanswered.
“First, there is really no empirical evidence of sustainable cost controls that’s been found with that model,” Anderson said. “The second is that the goal . . . is really to provide four things and that is world-class quality, affordable care, coverage for everyone and immediate availability. . . . Many people would say that probably under these systems you can probably choose three of the four, but it’s hard to have all those together.”
Last month, it was announced that Advocate and Westmont-based Chicago Health System, which is part of Vanguard Health Chicago, would be among the 89 organizations to participate in a similar ACO program for Medicare patients.
