IBJNews

Franciscan doubles down on accountable care

Back to TopCommentsE-mailPrintBookmark and Share

Franciscan St. Francis Health earned a $6.6 million bonus from the Medicare program for its success at keeping central Indiana patients out of the hospital and the emergency room. So the hospital system will expand its participation in so-called accountable care programs to all its Indiana territories.

That performance ranked Franciscan in the top five out of 32 groups of health care providers participating in the Medicare Pioneer ACO program—one of the Obama administration’s earliest tests of a key Affordable Care Act strategy for controlling future increases in health care costs.

Franciscan actually reduced spending—a rarity in health care—on 20,000 Medicare patients in 2012 compared with the cost of care those same patients received annually in the three previous years.

The federal Medicare program, the largest health plan for seniors, projected it would spend $230 million last year to care for the 20,000 patients, based on their health status and claims experience. That number represented a 4.8-percent increase over the average annual amount Medicare had paid to care for those same patients in 2009 through 2011.

Franciscan’s efforts to keep the patients healthier and out of the hospital led to spending $216.7 million on them—a 6-percent reduction from Medicare’s projected amount. The federal Medicare program will pay Franciscan a bonus of $6.6 million—its half of the $13.3 million Franciscan saved.

Franciscan executive Jay Brehm said accountable care is a key strategy for Franciscan’s future success.

“There is a lot of support throughout the organization,” said Brehm, senior vice president of strategic planning and business development for Franciscan Alliance, the Mishawaka-based parent Franciscan St. Francis Health. “We think it helps Franciscan improve its service offerings and value to the payers and the beneficiaries that seek our services.”

The overall results of the Pioneer ACO were mixed. Franciscan was one of just 13 participants that saved money compared with their expected spending. Four spent more than their target and 15 spent the same. Nine organizations left the program after the first year.

But combined, the 32 organizations spent $87.6 million less than projected by Medicare’s actuaries. In order to be eligible for bonus payments, they also had to report quality data in 15 areas.

Among all the Pioneer ACO participants, spending still went up—0.3 percent compared with the average over the previous three years. But that was less than the 0.8-percent increase in the cost of care for similar Medicare beneficiaries, according to an analysis by the Centers for Medicare & Medicaid Services, the federal agency that administers the Medicare program.

Franciscan’s care actually cost Medicare less than it had been paying—about $2.8 million less than the annual average in the three prior years. That represented a 1.3-percent spending reduction.

Franciscan achieved savings by reducing the number of patients coming back to the hospital a second time for the same condition, reducing patients’ use of the emergency room, and by working with long-term care providers to shorten patients stays by improving their health faster.

Franciscan identified about 2,000 patients it deemed in need of in-home visits and other interventions from its team of complex care nurses and social workers.

Franciscan identified those patients by running their past Medicare claims through predictive modeling software, which essentially identified patients suffering from or were at high-risk of developing three chronic diseases: diabetes, congestive heart failure or chronic obstructive pulmonary disease—or in many cases, all three.

“Most of those people were hitting the ER a lot. Most of those people had readmissions. Most of those people had 15 to 20 medications,” said Jenny Westfall, regional vice president for Franciscan ACO.

These high-need patients also had transportation and income issues that frequently prevented them from getting the care they needed.

“We’ve used a lot of social workers to help these patients," Westfall said. "They don’t have a lot of support at home. Oftentimes, they have no transportation. They don’t have the money to buy the prescriptions that we prescribe for them when we send them home. So we just did a lot of hand-holding.”

Franciscan also identified patients in need by surveying the roughly 700 physicians who are part of its Pioneer ACO organization. Those doctors will get a chunk of the $6.6 million bonus, Brehm said, but the size of their take has yet to be decided by Franciscan executives.

The rest of the bonus, he said, would be reinvested in Franciscan’s in-house systems and personnel that support its ACO programs.

In addition to the 2,000 patients who received home visits and coaching, Franciscan placed telephone calls to about 75 percent of its 20,000 patients. And all patients received written materials about the Franciscan ACO, which included educational materials about various health conditions.

Franciscan is trying to keep those efforts going this year. It also has to step up its game on its quality metrics. To qualify for another bonus, it has to hit goals set by Medicare.

But Franciscan is committed to making it work. The system plans to start two new ACOs by year end. One, in the Lafayette area, will likely include 10,000 Medicare patients. Another, in northwest Indiana, will include 10,000 to 12,000 patients.

Franciscan is also operating two other accountable care organizations. One is a partnership with Indianapolis-based physician group American Health Network. That organization includes about 28,000 Medicare patients. The other is a partnership with Union Hospital of Terre Haute, which includes about 14,000 Medicare patients.

So by year’s end, Franciscan will be serving at least 82,000 patients in its accountable care organizations.

ADVERTISEMENT

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by
ADVERTISEMENT

facebook - twitter on Facebook & Twitter

Follow on TwitterFollow IBJ on Facebook:
Follow on TwitterFollow IBJ's Tweets on these topics:
 
Subscribe to IBJ
  1. I am a Lyft driver who is a licensed CDL professional driver. ALL Lyft drivers take pride in providing quality service to the Indianapolis and surrounding areas, and we take the safety of our passengers and the public seriously.(passengers are required to put seat belts on when they get in our cars) We do go through background checks, driving records are checked as are the personal cars we drive, (these are OUR private cars we use) Unlike taxi cabs and their drivers Lyft (and yes Uber) provide passengers with a clean car inside and out, a friendly and courteous driver, and who is dressed appropriately and is groomed appropriately. I go so far as to offer mints, candy and/or small bottle of water to the my customers. It's a mutual respect between driver and passenger. With Best Regards

  2. to be the big fish in the little pond of IRL midwest racin' when yer up against Racin' Gardner

  3. In the first sentance "As a resident of one of these new Carmel Apartments the issue the local governments need to discuss are build quality & price." need a way to edit

  4. As a resident of one of these new Carmel Apartments the issue the local governments need to discuss is build quality & price. First none of these places is worth $1100 for a one bedroom. Downtown Carmel or Keystone at the Crossing in Indy. It doesn't matter. All require you to get in your car to get just about anywhere you need to go. I'm in one of the Carmel apartments now where after just 2.5 short years one of the kitchen cabinet doors is crooked and lawn and property maintenance seems to be lacking my old Indianapolis apartment which cost $300 less. This is one of the new star apartments. As they keep building throughout the area "deals" will start popping up creating shoppers. If your property is falling apart after year 3 what will it look like after year 5 or 10??? Why would one stay here if they could move to a new Broad Ripple in 2 to 3 years or another part of the Far Northside?? The complexes aren't going to let the "poor" move in without local permission so that's not that problem, but it the occupancy rate drops suddenly because the "Young" people moved back to Indy then look out.

  5. Why are you so concerned about Ace hardware? I don't understand why anyone goes there! Every time ive gone in the past, they don't have what I need and I end up going to the big box stores. I understand the service aspect and that they try to be helpful but if they are going to survive I think they might need to carry more specialty parts.

ADVERTISEMENT