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BJC Accountable Care Organization is turning 10. How well do you know it?


August 01, 2022
August 01, 2022

In 2012 BJC became the first health care provider in the St. Louis area to take on the challenge of forming an accountable care organization (ACO) to take better care of seniors. Ten years later, about 38,000 patients are covered and the organization has regularly met its goals of reducing the total cost of care while improving care quality.

ACOs were started when the Centers for Medicare and Medicaid Services (CMS) finalized new rules under the Affordable Care Act to help doctors, hospitals and other health care providers better coordinate care for Medicare patients. ACOs create incentives for health care providers to work together to treat patients across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program rewards ACOs that lower health care costs while meeting or exceeding standards on quality care.

Today, the program includes 483 ACOs across the country serving 11 million Medicare beneficiaries and generated $11.2 billion in savings. In 2020, the last year numbers are available to BJC, BJC ACO generated $12.7 million in savings with a patient quality score of 98.75%. In fact, from 2012 to 2020, BJC ACO saved Medicare $56 million and served 106,500 seniors.

“BJC Accountable Care Organization includes all BJC hospitals, BJC Home Care and BJC Medical Group. Everyone in the BJC family is part of this team,” says Doug Pogue, MD, president of BJC Medical Group and BJC ACO.

“The benefit to a patient from this expanded focus on care coordination really comes from the ability of the patient and his or her physician to share information; to sit down and have a conversation about their care needs,” says Dr. Pogue. “This results in an individualized care plan that the patient and physician develop together related to his or her health status with a flow of information that goes to every single doctor and other clinician involved with the patient’s care. It allows everyone to be on the same page as the primary care physician.”

Several programs put into place in the last 10 years have resulted in patients getting a higher level of care with less costs. 

“ACO patients receive care from a robust clinical team, including nurses, care coaches, social workers, and pharmacists – which leads to better outcomes and satisfaction for patients and providers,” says Nathan Moore, MD, BJC ACO medical director. “Team-based care is the future of primary care and we are excited to be leading the way.”

“We have worked to reduce our hospitalization numbers, and we have seen a decrease in unnecessary testing, particularly with MRIs,” according to Nancy Patterson, vice president and chief nurse officer for BJC Medical Group. 

Patterson also points to the care management team who follow patients by phone and help with physician orders, medications, education about their health condition, and other needs such as transportation to doctor appointments. “Helping patients transition home from the hospital have been particularly successful,” she says.

“Patients benefit from working with a care manager,” Megan Guinn, director of clinical improvement, says. “They help patients stay independent and out of hospitals by providing them with education about their condition and connecting patients and family members to helpful resources. Our work toward preventive care and wellness measures resulted in quality reward points for significant improvement.”

Innovative programs are also part of the ACO, such as remote COVID monitoring or using Bluetooth-enabled devices and tablets to manage patients after being discharged from the hospital. Patients who have congestive heart failure or chronic obstructive pulmonary disease (COPD) receive the devices which help identify any abnormal vital signs, weight, or survey responses that may be an early indicator of a worsening of the patient’s condition.

After 10 years, the BJC ACO still makes sure patients succeed in their health care journey. “When you throw a pebble in a pond, the circles continue to expand,” says Dr. Pogue. “The ACO vision is similar. We are taking what we learn and applying it to how we take care of patients even outside of the ACO. It is how care will one day be delivered for all of us.”

BJC ACO By the Numbers

2020 BJC ACO Overall Quality Score – 98.75%
BJC’s Savings for Medicare in 2020 - $12.7 million
Between 2012 and 2020, BJC ACO saved Medicare $56 million and served 106,493 beneficiaries
COVID Home Monitoring Program – over 30,000 enrolled

 

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