Making Healthcare More Accountable for Patients and Payers

Carol Robicheaux describes herself as a “very young 70.” These days, she’s feeling better because she’s more knowledgeable, more engaged and more empowered about her health. A year ago, her outlook wasn’t so positive. Back then, life for her was a revolving door of emergency room visits and hospital stays to address blood pressure, pneumonia and congestive heart failure issues.

Today, Robicheaux is a walking testimonial of the care she received through the Memorial Hermann Accountable Care Organization (MHACO) – her life changed, she said, through constant communication, education, and appropriate clinical interventions. Now, she’s eating better, exercising and socially engaged.

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What Is an ACO?

For many healthcare consumers, the term “accountable care organization” is an extraneous healthcare term that has little meaning. But ask patients like Robicheaux and they may attest that their care in an ACO was a “godsend.”

The MHACO consists of a network of affiliated physicians who practice evidence-based medicine to achieve better clinical outcomes and shorter hospital stays all at a cost savings to patients and providers. They do this through a process called clinical integration where healthcare providers share information about a patient’s care, allowing them to glean a complete picture about a patient’s health and  deliver care that is seamless, coordinated and ultimately, more cost-effective. MHACO physicians also work to keep patients like Robicheaux out of the hospital by employing a proactive approach to identify patients at risk of illness before they become ill.

Case in point, the MHACO saved more than $89 million in 2015 while caring for 50,055 elderly patients and earning a quality score of 96 percent, in Centers for Medicare and Medicaid Services results released recently. The MHACO has been the top-rated CMS Medicare Shared Savings Program in the country since it launched three years ago, saving nearly $200 million overall.Senior man working in a greenhouse

ACOs Deliver Care That’s More Coordinated and Cost-effective.

Last year, Robicheaux experienced a number of health issues, but an inconsistent heart rate and low blood pressure sent her to the Emergency Center. She subsequently had to be hospitalized. She was released, but had to return after contracting pneumonia. After recovering from pneumonia, she was back in the hospital for congestive heart failure.

“My blood pressure had dropped to 28,” Robicheaux recalled. “I walked into the hospital and they had a list of all of my medications, my last EKG and everything within 10 minutes. I was really shocked, but I was so happy. I do take a lot of medications and when you have a low blood pressure reading the mind doesn’t think real clearly.”

The hospital experience was one aspect, but the home health component of her care made Robicheaux a believer. Memorial Hermann’s Virtual Care Check team remotely monitored her health daily. She was provided a tablet computer with a 4G wireless connection, a weight scale, pulse oximeter, and blood pressure devices. She followed her physician plan by logging on daily to answer questions related to her health and to track her vital signs.

Her care manager, Lynette Lloyd would ask questions and then coach her on how to manage her symptoms and avoid complications and then shared updates electronically with Robicheaux’s physician to optimize her care coordination.

“She would call me and we’d talk, and we’d talk, and we’d talk,” Robicheaux said. “She is so wise and knowledgeable and patient. She always made great recommendations and was willing to listen and talk me through any issue that I had.”

ACOs Keep Patients Healthier and Out of the Hospital.

Lloyd said as Robicheaux became more educated about her health she became more confident and engaged in helping to manage it.

“At first she was very anxious,” Lloyd said. “But our pharmacist worked with her to educate her about the medicines she was taking. We also assigned her a health coach. She started walking and then started doing water aerobics. Now, she’s losing one to two pounds a week and becoming more socially engaged.”

“It saved me a lot of time with my doctors,” Robicheaux continued. “I was going in the hospital because they couldn’t regulate my blood pressure. But with my doctor receiving this information, I did not have to go into his office or the hospital for this.

Nishant Anand, M.D., FACEP, as Sr. Vice President &Physician-in-Chief for MHMD, said the goal of the MHACO is improving the coordination of care and redefining the delivery of care through innovative models.

“We are building the type of coordinated, holistic care that we would want for ourselves and our loved ones – a model that truly emphasizes enhancing the health and wellbeing of our patients rather than simply providing ‘sick’ care,” Dr. Anand said.

“The program (MHACO) really was a godsend,” Robicheaux said. “My brother died of congestive heart failure and that scared me so much. Everything they (MHACO) did was about getting me on my feet and helping me understand why I had this condition and why I needed certain treatments. It’s such an excellent, excellent program.”

To learn more about the Memorial Hermann Accountable Care Organization, visit here.

To learn more about Virtual Care Check, visit here.

To find a physician affiliated with Memorial Hermann, click here.

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