How Home Health was Vital to a Texas ACO’s Formula for Success

Physicians at a large practice in Amarillo, Texas, were able to slash hospital readmissions by 23% and realize millions in savings after forming an Accountable Care Organization (ACO) last year. The secret to the group’s success: a laser-like focus on home health care.

Using a series of sophisticated algorithms, Amarillo Medical Specialists targeted the clinical and claims data of nearly 11,000 Medicare patients—the goal being to follow the money and identify gaps in care, specifically how often their patients were readmitted to the hospital post-discharge, according to a recent article from Forbes.

The group found that getting patients into a doctor’s office within a week of discharge made a world of difference, which in turn translated into hospital readmissions falling 23% and Amarillo coming under budget by $5 million last year, an amount that the group split in half with Medicare—a defining initiative of the ACO structure that steps away from fee-for-service and instead rewards organizations for keeping their patients healthy and out of costly settings like the hospital.

Recognizing that home health care embraces this concept of diverting patients from costlier care settings, Amarillo used some more analytics to score home health care agencies based on how long they billed Medicare, how often patients cared for by home health workers visited the emergency room or were readmitted to the hospital soon after discharge. 

But the formula to Amarillo’s success is far more than algorithms and analytics. Rather, it relies heavily on the cooperation between the providers coexisting within the ACO network that produces the best results.

“It’s a complicated equation,” said William Biggs, chief medical information officer at Amarillo Medical Specialists, in the Forbes article. “It isn’t, we’ll just put that into a formula and bring in [IBM] Watson to tell us everything we need to do. It’s all about relationships.” 

Read more at Forbes.

Written by Jason Oliva

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