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Park Nicollet’s Pioneer ACO Initiative

May 16, 2013
by John DeGaspari
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A learning experience for one healthcare provider
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At a morning breakout session of the HCI Executive Summit, Sam VanNorman, director of business intelligence, and Curtis A. Boehm, M.D., chief medical information officer, gave their perspectives on Park Nicollet Health System’s experience as a Pioneer Accountable Care Organization.

Park Nicolette is an integrated care organization in the Mineapolis area, woith 1000 physicians on staff and 55 medical specialties. Earlier this year it merged with HealthPartners. 

According to Boehm, its patient population includes 4000 frail and elderly patients on an average of 16 medications, as well as on 16 medications, and treats 25 percent of the patients in the state with mental illnesses.

“We need better solution to control the cost of care, and continue to provide care,” he said. He said that achieving the triple aim of healthy populations, improving the experience of care, and decreasing the cost of care will require a paradigm shift.

With that in mind, it entered into the ACO world, as part of the Provider Group Practice transition demonstration project. As part of the shift, Park Nicollet has contracted with many payers in the state as part of its delivery of care, and it continues to move in this direction, he said.

According to VanNorman, the PGP demonstration project has been a learning experience for the health system. He says it is not in competition with other ACOs in the Twin Cities area.

He calls shared savings as something of a double-edged sword, because the system has to pay back money if it doesn’t deliver on shared savings. He said the hospital spends money on its project, in the form of high overhead costs; and it is also has lower revenues from lower admissions.

As a Pioneer ACO, Park Nicollet is paid through cost savings, contracted shared risk, and quality measures. He said the health system has been doing a lot of this for a long time. There is give and take on what make appropriate benchmarks, he said. “This takes a lot of resources, and there is a lot of nuance: We have measures that are allegedly same as other ACOs, but they are not,” he said.

VanNorman said he said he didn’t think quality measures were meant to correlate with savings; they are meant to improve care.

He said analytics has allowed targeting of high-risk patients. “We are feeding back a lot of pioneer data for their populations,” he said.

 VanNorman said that the health system’s population health tactics includes readmissions reduction; care conferences; care consultant programs; care team attribution; senior services redesign; a congestive heart failure program, which he calls a big area of opportunity area; mental health focus; and advanced directives. These are not localized efforts, and the health system is coordinating those tactics along the patient populations, he said.
He named several analytics challenges, including dealing with claims data, participation requirements, rapid change, and IT system limitations, and attribution. 
Operational challenges the EMR inclusion model, new models and services. “This has changed the way physicians treat their patients, we are changing our care model,” he said.

VanNorman said a lot of analytics is focused the descriptive, or what happened. The next step is preductive; but the goal is prescriptive—what caregivers should do. He says the health system is still at the descriptive stage.

Among Park Nicollet’s projects include a CHF TelAssurance program, in which patients receive a reminder, weigh themselves. The information goes into a database, and if necessary the nurse is notified to contact the patient to help modify the patient’s weight.

Another is a readmission project to, while patients are in the hospital, predict the patients who are at the highest risk.