Hospital Board considers joining ACO

Caravan Health’s Sue Deitz presented to the Adams County Public Hospital District No. 2 Board of Commissioners on Feb. 22 regarding the district’s interest and possibly joining an Accountable Care Organization (ACO).

While not currently mandatory for hospital districts to join an ACO, CEO/CFO Gary Bostrom noted in the future, it could be a requirement for the district.

ACOs are groups of hospitals, doctors or other healthcare providers who provide care to Medicare patients.

Deitz explained Medicare is trying to keep their doors open, and CMS has created models and demonstrations around a common theme. It follows the Triple Aim method: better care, patient life and a better end.

She continued to explain there are 34 quality measures tracked every year, and the savings from each hospital is shared between CMS and the ACO. Deitz explained an ACO must be comprised of 5,000 lives: Medicare patients who receive their primary care from those in the ACO.

For East Adams Rural Healthcare, the facility has between 150-200 lives attributed to the district. Deitz explained these are Medicare patients who receive primary care through a doctor in the district’s clinic.

She added in 2019, there will also be attribution for patients who have NPs and PAs.

The bonus program offered through Caravan, ACO members do not have pay if they do not have savings during the year. Each member has a benchmark to meet, and the reimbursement does not change. Deitz added value-based models are not going away.

Deitz explained the goal for each member is to lower the amount of spend “per life”. The benefit of Caravan’s program is value-transformation without risk, she added.

Joining an ACO would also help strengthen providers’ reputations by hospital compare filling in provider reviews to main websites where potential patients search for physicians.

Deitz said Caravan has worked with EARH in the past, except previously it was for coding and assisting with wellness reviews.

Caravan Health is geared towards making ACOs shine, Deitz stated, and the company has an accountability scorecard to ensure ACOs are supported.

Deitz said Caravan provides monthly trainings by phone, and also provides quarterly conferences for a variety of departments within the district. If EARH agrees to join an ACO through Caravan, it is a three-year term and the district can stay in for two terms.

Caravan records savings higher than the national average and allows ACO members to focus on wellness, prevention and screening for their patients.

The services Caravan provides include application completion, recruitment, establishing the ACO, setting goals, work plans, accountability and training to help provide the district with the best trained nurses possible, while assisting with coding.

The cost to submit an application is $10,000, but Deitz said if EARH signs up before March 31, they will receive a $2,500 discount. From there, the cost is $2,500 per month, which is the minimum cost for ACO members, as EARH is a small district.

If EARH joined Caravan, the term would start in January 2019. Caravan currently has 285 facilities as part of their network.

After Deitz’ call, the Commissioners and CNO Jennifer Pepperd discussed the potential benefits of joining an ACO. Pepperd currently works with Caravan through the wellness review program.

She hesitated to recommend joining an ACO because of the cost to the district, both in financial start up costs, as well as the need to hire more personnel for roles like care coordinator and other social service needs. Pepperd said this could also include the need to hire an additional physician, depending on the specifications of the contract with Caravan.

Bostrom stated the fear is the district may be forced into joining an ACO in the future, and it is the commissioners’ decision if they want to take a more proactive approach or wait until that decision is made, if it ever is, he added.

Commissioner John Kragt requested the District research other ACOs of similar size to see their benchmarks and the benefits of being a part of the ACO. He added he would also like to review Caravan’s contract before the commissioners make a decision on the matter.

The Commissioners agreed to forward questions to Bostrom in order to have answers from Deitz at the next meeting. Bostrom said there is not a rush for the commissioners to make the decision, but will work to compile as much information as possible before the next meeting.