After a weeks-long battle over disproportionate share hosptial payments, not to mention months figuring out how to close a budget gap in the hundreds of millions, NYC Health + Hospitals is celebrating a victory thanks to its accountable care organization. The system's ACO has achieved shared savings for the fourth consecutive year, a milestone they say is unique to them as the only program in the state to achieve such shared savings success.
The H+H ACO saved the Medicare $3.59 million for 2016 and returned $1.58 million in shared savings to the public health system. Thanks to the enhanced care coordination, the health system has prevented unnecessary emergency department visits, avoided many unnecessary hospitalizations and other high-cost care. There are more than 10,000 Medicare fee-for-service patients that are followed through the program.
"Our results are important, not just for the success of our health system, but for other health care providers nationwide," said Stanley Brezenoff, interim president and CEO of NYC Health+Hospitals. "It shows that a public health care system that cares for the most complex patients can achieve the highest standards of performance--that even a public health system with modest resources and multiple transformation efforts underway can still improve care for some of the most complex patients. It can be done. And it should be done."
NYC Health+Hospitals' ACO scored 90 percent for their quality performance measures, reflecting a composite of 34 different quality metrics like 30-day all-cause hospital readmissions and measures reflecting patients' control of such conditions as hypertension and diabetes.
Also, for the first time, the ACO got a perfect score in the "At-Risk Population" domain, which contains measures pertaining to patients who are more likely to experience a hospitalization or the recurrence of a condition, such as depression.
Because of its Medicare Shared Savings Program success, NYC Health + Hospitals has applied to the New York State Department of Health to become a State All Payer ACO, which would change the payment structure for coordinated care for Medicaid fee-for-service patients and privately insured patients as well.
The federal Medicare Shared Savings Program holds participants accountable for the cost and quality of care delivered to a defined patient population over time.