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BJC hopes ACO designation means better coordination of services

This article first appeared in the St. Louis Beacon, July 17, 2012 - BJC HealthCare system is adopting a new philosophy of care for the elderly.  The change will occur because BJC Healthcare has become an Accountable Care Organization, a federal designation that is supposed to spur hospitals to focus with CAT scan accuracy on issues to improve quality and cut cost.

This new model is a response to what federal health officials say is a disjointed medical treatment system for many Americans over age 65. Two out of three suffer from several chronic conditions that are treated by different doctors, many of whom are said to coordinate the patient's care about as well as a surgeon would perform an operation with two left hands.

The Centers for Medicare and Medicaid Services says on its website that the system subjects many elderly patients to needless medical errors, costly duplications of health services and avoidable hospital readmission rates. Add to these flaws, it says, are patient frustrations over "having to share the same information over and over with different doctors."

CMS projects that the ACO model, which is part of the Affordable Care Act, will not only improve quality but will save the federal government an estimated $940 million over four years. BJC is one of two ACOs designated in Missouri. The other is Heartland Regional Medical Center in St. Joseph. The two are among 89 ACO designations announced last week, all part of a second wave of ACOs. They will serve an estimated 1.2 million Medicare patients. An initial group of 32 pioneer ACOs set up earlier already serve about 2.4 million beneficiaries.

"The ACO is designed to make sure there is better coordination among all the partners involved in the care," says June Fowler, vice president for corporate and public communications for BJC Healthcare. "You achieve two things -- better patient outcomes and lower cost."

She cites the hypothetical example of a patient being treated for a chronic heart condition by one or more of the 200 physicians on staff at one of the 13 hospitals in the BJC network. Patients joining the ACO might not notice any difference, Fowler says, except for more interaction between providers and patients. Already, the system has begun hiring more case managers and would have done so even if it had not been designated an ACO, Fowler said. 

"You want to do more outreach and better coordinate that patient's care," Fowler says. "That means all parts of the system will talk to each other. That can include the cardiologist, the primary-care physician, a nurse practitioner, a case manager," and those who might provide home health services as well as the patient and the patient's family.

"Everybody's linked to the care plan," she says. If the patient is expected to follow up with a cardiologist within 10 days, she says the system doesn't rely on the patient to call the cardiologist. "Instead, those same instructions will go to the cardiologist and to the primary-care physician. And there is also outreach to the patient and the patient's family to make sure the patient gets in to see the doctor."

Fowler says, "In the best of all worlds, that is what happens now, but it's not hard wired into the system. This (ACO) approach puts everybody into the same protocol, making sure they understand their opportunities and responsibilities to help better manage the care of that patient."

Savings are expected to result, Fowlers says, because "if you are able to better manage the patient's care, the potential of the patient going back into the hospital is reduced."

If an ACO sounds like the old managed care concept, it is different in that patients are allowed to keep their physicians of choice. She is unsure how many Medicare patients will choose to become part of the ACO.

"But we believe that this kind of care coordination model, which I consider more holistic, can be expanded across" the BJC network.

Although a health system does not get extra money for volunteering to become an ACO, Fowler says participating hospitals will share in long-term savings "that will be achieved by taking some of the cost out of the system."

She says BJC began looking at the model about 15 months ago and decided that "there were potential benefits in terms of better patient-centered health outcomes."

Some of the shortcomings CMS is seeking to address through ACOs always have been on the radar screens of most hospitals. But even highly praised health systems, such as BJC, have shown how easy it is to slip on quality. In spite of its excellent medical staff and state of the art facilities, the hospital has had to work extra hard to reduce avoidable readmission rates among some Medicare patients for heart attack, heart failure and pneumonia.

"What has become evident is that those being readmitted don't come back because of what happened to them while in the hospital," Fowler says. "These patients come back because the transitional care plan, the discharge instructions that have been given, have not been followed for whatever reasons."

That awareness led to one ACO-like change, the addition of case managers to help coordinate care and more outreach, for example, to "make sure the patient is taking medicine appropriately and is on the path to getting better" when recuperating away from the hospital.

"We are pleased to have been selected, and we think it will benefit patients. That's why we are all here."

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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