Southwestern Health Resources Leveraging Home Health to Achieve ACO Success, Lower Total Cost of Care

Southwestern Health Resources (SWHR) is an integrated health care network formed in 2015 with the purpose of filling gaps in care. It’s also part of one of the top Next Generation Accountable Care Organizations (ACOs) in the nation.

Having an unwavering commitment to lowering “total cost of care” has been a main factor in that Next Gen ACO success, Dr. Jason Fish, the chief medical officer at SWHR, told Home Health Care News. Having multiple home-based care programs — both internally and through preferred provider relationships with area home health agencies — has likewise played a major role.

“When you’re in value-based care, you recognize very early on that you cannot do this alone,” Fish, a general internist by training, said. “You will not be successful just as a provider group in this. And so those [home health] partnerships are critical.”

Broadly, the North Texas-based SWHR is made up of an academic medical center, University of Texas Southwestern, and a community-based health system, Texas Health Resources. The network has thousands of independent primary care physicians and specialists under its umbrella as well, including Dr. Fish.

In addition to being one of the biggest health care providers in Texas, SWHR is also the parent organization of Care N’ Care Insurance Co., a regional Medicare Advantage (MA) Plan that serves about 14,000 members in the Lone Star State.

“What helps us be successful is, No. 1, our physicians are engaged,” Fish said. “No. 2, the partnerships that we have with the various agencies in our area. And then No. 3, our approach.”

About five years ago, SWHR was selected by the U.S. Centers for Medicare & Medicaid Services (CMS) to participate in the Next Gen ACO program, a value-based care initiative designed to build upon both the Pioneer ACO concept and the Medicare Shared Savings Program (MSSP).

The first performance year for the Next Gen ACO program was 2016. Today, there are just 35 ACOs participating in the alternative payment model, according to CMS.

Avoiding gaps in care

Based on financial performance and quality, SWHR is recognized as one of the top 10 ACOs in the U.S. — not just ACOs in the Next Gen lane. Based on CMS data, SWHR is specifically No. 7 out of more than 600 ACOs in the nation in terms of Medicare savings.

Overall, SWHR’s “Accountable Care Network” has saved CMS more than $73 million over the past three years, including over $37 million in 2016. The ACO manages care for nearly 87,500 Medicare beneficiaries in Texas.

“We’ve been in this space of value-based care for many, many years,” Fish said. “And we’ve been in it as a Next Gen ACO for the last three. We’ve been highly successful in that, being one of the top performers in terms of total cost for three years in a row.”

The organization is able to lower cost of care and save the system money via its two-pronged approach.

On one hand, SWHR uses retrospective data to identify risk in the present. On the other, it uses predictive analytics, geocoding and more to analyze future risk.

“We already do well in this space. But we recognize that if you don’t go upstream and really look at it from that vantage point, then tomorrow, you’re going to have another set of patients who foot the bill,” Fish said. “And really, that’s not our goal. We don’t want anybody to have to be hospitalized acutely.”

To avoid gaps in care, SWHR has invested in several internal in-home care programs.

One of the best examples is its home-based geriatrics program for the homebound. As part of that effort, SWHR sends providers into the home, plus labs, testing and other services when needed.

“It’s really managing those individuals because many of them have underlying cognitive impairments, so it’s best to keep them in an environment that’s familiar,” Fish said. “But we don’t stop there.”

While the home-based geriatrics program is for older sicker patients in need of immediate medical attention, SWHR also has a preventative care operation for people who are at risk for an adverse health event, such as a hospitalization. It’s through this work that SWHR is able to monitor social determinants of health and other important considerations, the CMO noted.

“You look at something as simple as a diabetes test or a retinopathy screening for those with diabetes,” he said. “We’ve then created solutions to bring these to the homes.”

Finally, SWHR additionally runs a home-based care program for patients who have kind of gone AWOL.

“We have a team that goes and tries to reconnect with them, to go through their chronic diseases and get them back on plan and connected back with their PCP,” Fish explained.

In May, the Biden administration somewhat surprisingly revealed that it will not extend the Next Gen ACO model, which is expected to end at the end of 2021. The program was initially set to end at the start of the year, but it was extended by the previous administration because of the public health emergency.

Many, including the National Association of ACOs, were disappointed by the move.

‘These partnerships have been incredible’

Beyond its in-house efforts, SWHR has a long list of home-based care partnerships.

In January, for instance, it announced a partnership with Huntington Beach, California-based Landmark Health, one of 53 direct-contracting entities and a large provider of in-home medical care. The partnership’s goal: to provide longitudinal care to seniors with complex medical needs.

“Landmark will reach those patients who need greater support with in-home medical visits – these can augment the already excellent care our community of physicians provide,” Dr. Sanjay Doddamani, SWHR’s chief physician executive and COO, said at the time.

Over the past several years, SWHR has built a vast preferred provider network with high-quality home health agencies and skilled nursing facilities (SNFs) operating in North Texas.

To be a part of that network, SWHR holds home health agencies and SNFs to a very high standard, with each group having to meet certain quality metrics.

“While we have a team of social workers, navigators and … nurses, it’s the home health agencies that deliver the extension of the physician practices,” Fish said. “They are absolutely going to be critical in ensuring that, you know, those chronic diseases or acute situations are managed. They’re the eyes and ears of the physician in the home.”

Home health partnerships were especially vital during the worst stretches of the COVID-19 pandemic, he added.

“These partnerships have been incredible, particularly when COVID was at its height,” Fish said. “It was the home health group that was able to flex, to wraparound patients very quickly that were in need and stand up some home care programs around COVID, … particularly the elderly who were quarantined and alone.”

Looking ahead, Fish anticipates that SWHR will continue to invest in home-based care, with the pandemic creating a sector-wide shift likely to last for the foreseeable future.

“We’re going full force on ‘the home,’ whether that’s hospital at home, sending physicians into the home or doing testing,” he said. “We are going full force with that, really trying to meet the consumer, the member, the patient wherever they are.”

The post Southwestern Health Resources Leveraging Home Health to Achieve ACO Success, Lower Total Cost of Care appeared first on Home Health Care News.