Hospitals and insurance companies are always looking for ways to save a few dollars without compromising care.
And that’s what Indianapolis-based St. Vincent Health System and its partner, MissionPoint Health Partners, based in Nashville, Tennessee, say they were able to accomplish in the first year of a new three-year arrangement.
The two sides had created what is known as an accountable care organization—a fairly new kind of set-up in health care. Under the deal, St. Vincent was financially accountable for what it would spend on care for about 21,000 employees and dependents. If it spent too much, it would have to swallow the expenses.
MissionPoint, for its part, was responsible for setting up a model that would provide care, cut unnecessary costs and help St. Vincent save money.
The two operations are both part of St. Louis-based Ascension, the nation’s largest not-for-profit health system.
MissionPoint said it used proprietary algorithms to help determine exactly which members were driving costs or were at a high risk for a “significant health event” or costly chronic and often preventable condition.
Then it directed resources to those high-cost and high-risk patients, to help them get better control of their health. MissionPoint assigned “local care guides” to help the members navigate their critical care and solve underlying issues that might have been impeding progress.
“One of the things we worked on was how we do this in a way that increases services we give to you, versus just saying, ‘you can’t do this, you can’t do that,’” said Dr. Jordan Asher, chief clinical and innovation officer for MissionPoint.
What are some of those things? Often, it’s just psychological or social issues—such as diet, exercise and anxiety—that inhibit health improvement, he said.
“What are your barriers to your own care?” he said. “We’ll work on those.”
At the end of the first year, the savings amounted to $5.8 million, largely due to cutting unnecessary emergency room visits, using a larger percentage of generic drugs compared to more expensive brand drugs, and decreasing hospital admissions and readmissions, MissionPoint said.
St. Vincent officials confirmed the savings, but did not offer additional comments.
Accountable care organizations are growing in popularity, as hospitals come under greater pressure to reduce the cost of care. Under the model, the hospital set up their own health plans, taking the risk they can keep costs lower and reap the savings.
In February, Anthem Blue Cross and Blue Shield announced that it had helped the Franciscan Alliance hospital system save about $22 million, while showing improvement in patient care across a wide variety of measures. Those included diabetes patients staying on medications, a decrease in inpatient admissions and improvement in treatment for acute and continuing episodes of depression.
MissionPoint did not have specific figures for medical outcomes at St. Vincent. But according to a marketing brochure, the impact of embedding a health partner in a large primary care provider practice for six months can reduce ER visits by 13 percent and inpatient admissions by 22 percent.
“The only caveat is that over time, there is a cost to delivering care that people need,” said Dr. Asher, an internal medicine specialist. “You can’t get all the way down to zero, because what we do is take care of people.”