Health System Demonstrates Optimal Patient Care Doesn't Require a Hefty Price Tag
NEW YORK (October 18, 2017) - Montefiore delivered excellent patient care and generated more than $73 million in savings to Medicare as a Pioneer Accountable Care Organization (ACO), according to new data from the Centers for Medicare and Medicaid Services. The Pioneer ACO model, which began in 2012, represents one of the federal government's first and most aggressive efforts to evolve Medicare payments to be based on quality and outcomes of care, rather than the number of patients seen. During the five year model, Montefiore stood out for providing transformational care where, when, and how patients needed it most - leading to money saved for CMS.
Montefiore was one of 32 healthcare organizations nationwide selected to be in the Pioneer model, and the only one in New York State. It has more than 20 years of experience being responsible for the quality and cost of care through performance-based arrangements, which reward providers for achieving or exceeding benchmarks for quality care, outcomes and efficiencies. Through Montefiore's optimal care, both the insurer and Montefiore were able to keep a percentage of their premiums, thereby saving money. The Pioneer model rapidly expanded the number of patients in these performance-based arrangements. Year-over-year, Montefiore steadily improved the care experiences and outcomes of Medicare beneficiaries.
In 2016 (Pioneer Year 5), the last year of the model, the physicians in Montefiore's ACO earned an exemplary 95.16 quality score. Its average performance rate was higher than all Pioneer ACOs in delivering immunizations, conducting preventive health screenings, and managing people's chronic diseases and acute conditions.
"Our performance in the Pioneer ACO is proof that when a health system like Montefiore – working with aligned hospitals, physicians, ambulatory care, and residential care, takes responsibility for the quality and cost of care, we can all improve outcomes," said Steven M. Safyer, M.D., president and chief executive officer, Montefiore. "Montefiore is a national leader in value-based care and is pushing the boundaries of innovation through closer relationships with community based organizations and social services critical to addressing the socio-economic determinants of health."
In its final year, Montefiore's Pioneer ACO had more than 3,400 providers responsible for almost 54,000 Medicare beneficiaries. Montefiore performed above the mean Pioneer ACO scores for the way clinicians communicate. It also received top scores for the way patients rated their providers. Significant gains were also seen in key measurements such as body mass index and high blood pressure screening, as well as flu and pneumococcal vaccinations.
"Pioneer has provided us with an opportunity to strengthen and refine our model of value-based care," said Stephen Rosenthal, senior vice president, Population Health Management, Montefiore. "Through participation in Pioneer, we have developed sophisticated analytics and have used technology to effectively care for patients. Our model builds on the strengths of the doctor/patient relationship, providing coordinated care to address people's medical, emotional and social needs. We are applying what we've learned from successful Pioneer programs into newer risk-based models like the Next Generation ACO. This will lead to a greater number of patients and providers benefiting from these same improvements."