BJC ACO: the quality of care went up while the costs of care went down

BJC Accountable Care Organization (ACO) has once again improved patient outcomes while providing health care at a more efficient cost for Medicare beneficiaries, according to recently released performance data from the federal agency that administers Medicare. This has resulted in shared savings that will be distributed amongst ACO participants, including physicians and hospitals.

The Medicare Shared Savings Program rewards ACOs that lower health care costs while delivering high quality care. In 2020, ACOs were measured on CMS quality measures ranging from preventive health checks to use of computerized health records to preventing avoidable hospitalizations.

The BJC ACO overall quality score for 2020 was 98.75 percent, an improvement from 2019’s score of 93.13 percent. In addition to improving the overall quality of care, $12.7 million was saved for Medicare, for a total of over $44 million saved since BJC became an ACO in 2012.

Working together to improve the patient experience

According to Nancy Patterson, vice president and chief nursing officer for BJC Medical Group, during 2020 the COVID pandemic brought significant challenges in how we cared for our patients. “The rapid implementation of telehealth visits and remote monitoring for patients with COVID were instrumental in enabling us to safely care for patients during this difficult time,” she says. “Sharing information and providing education around the ACO’s initiatives and defining the providers’ roles helped our care partners better link with us to provide improved care to our patients.”

Megan Guinn, director of clinical improvement, says the ACO’s care management team works with patients with chronic conditions, including some transitioning home from the hospital. They help them understand discharge instructions and their medications while providing education on their conditions and scheduling follow-up visits with doctors.

“Patients benefit from working with a care manager,” Guinn says. “They help them stay independent and out of hospitals by educating them about their condition and connecting patients and family members to helpful resources.”

All health care is local

Improving the quality of patient care while lowering health care costs was only possible through better collaboration between patients, physicians and hospitals, according to Doug Pogue, MD, president, BJC Medical Group.

“The BJC ACO provides a full continuum of services through an integrated network of health care delivery settings in Missouri and Illinois,” Dr. Pogue says.

“BJC’s network of physicians takes care of seniors in a very integrated way. BJC ACO collaborates with physicians, making patients healthier and allowing us to follow patients during their care in a more coordinated, transparent way.”

Accountable care organizations empower local physicians, hospitals, and other providers to work together and take responsibility for improving quality, enhancing patients’ experiences, and keeping care affordable. The Medicare Shared Savings Plan creates incentives for ACOs to invest in care by allowing them to share in savings they generate after meeting certain quality and cost goals. Patients automatically receive the benefits of being part of BJC’s Accountable Care Organization when their physician joins. BJC’s ACO covers about 40,000 seniors with Traditional Medicare in the St. Louis area.

Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside the ACO.