By Aine Cryts
St. Joseph, Mo.-based Mosaic Life Care saved Medicare $8.53 million in its first year as a Medicare Shared Savings (MSSP) Accountable Care Organization (ACO). According to Brennan Lehman, Mosaic’s chief information officer, the health system has been successful because of support from leadership, strategic investments in technology, and by extending advanced care nurses into patient’s homes.
AXIS recently talked to Lehman about Mosaic’s ACO success and how that is transforming the way the health system serves patients.
AXIS: Tell me about your involvement in ACOs. Are you involved in more than one?
Lehman: We have a three-prong approach. We have a commercial ACO, we have our own caregivers who are self-insured, and then we’re involved in an MSSP ACO as well. And our experience has been fantastic across all three. For our MSSP ACO, we’ve been able to recoup savings from the Centers for Medicare & Medicaid for the past few years; we’re in both the upside and downside risk stream. And in our commercial ACO, we’ve done really well in our Kansas City market.
AXIS: What results can you share as a result of your ACO involvement?
Lehman: I think we’ve been successful because of our high-quality/low-cost approach to providing care. [According to Mosaic Life Care, as of September 14, 2014, the health system has received $5.1 million in shared savings as a result of its participation in the MSSP ACO. During the first year that Mosaic was in the program, it saved CMS $8.53.]
We’ve got one ski in the fee-for-service world and we’ve got another ski in the capitated [model] world. We’re getting to the point when we’re ready to drop a ski and just slalom into the capitated model world. Quality is high across the board, and that leads to better quality for all of our patients.
AXIS: What are some keys to Mosaic’s success?
Lehman: Having support from our board of directors has been key because moving to a capitated model requires a focused shift in how you run your hospital. We’re making a very decisive and significant shift from a fee-for-service model to a value-based model. As a result, we’re seeing a reduction in beds. If you don’t have your board very in tune with what your ACO strategy is and supporting that strategy, they’re going to wonder why they’re seeing decreasing beds. Thus far, we’ve seen that shift from 350 beds to now we’re running at 200 beds. And we’re seeing the shift from all of these specialized services taking place within the hospital setting—rather, these services are starting to move into the patient home.
The big thing a few years ago was the “smart” hospital room, where everything’s electronic. Today, we’re looking at the smart patient home. We can send a telemedicine pack out to that patient’s home, and they can plug it in and they’re good to go. And we can monitor them remotely—without having to drag them back into the hospital or the clinic. Because of our ACO involvement, we have a reimbursement mechanism for telemedicine.
AXIS: Where is Mosaic in terms of providing access to care in patients’ homes?
Lehman: As Mosaic continuously focuses on patient-centered care, expanding in-home services makes sense both from a population health and patient satisfaction standpoint. By expanding the use of telemedicine and advanced practice nursing care into patient homes, we find that we’re able to continue to maintain quality, improve outcomes due to helping patients become more compliant with care plans—and thus increasing continuity of care—decrease readmission rates, and avoid many of the pitfalls that come with patient care transitions. The programs at this point are assisting patients with congestive heart failure, COPD, and diabetes, but Mosaic will consistently look toward where these sorts of services make the most sense for the good of our patients.
AXIS: How does your EHR help support Mosaic’s ACO success?
Lehman: We have one single, integrated EHR with Cerner. We’ve developed technology within the EHR that allows physicians, care managers, pharmacists, and the entire clinical team to manage those patients. So no one has to jump out into one more system to check on a patient. It’s all integrated within our EHR across those different specialties; that way, there’s no miscommunication regarding patient handoffs. We also have a health information exchange that we use to share information with independent physicians.
About Brennan Lehman
Brennan Lehman is CIO of Mosaic Life Care (formerly Heartland Health), which has a life-care model that combines traditional healthcare with a focus on key life elements that affect overall wellness.
He received a bachelor’s degree in business administration/marketing from Northwest Missouri State University in Maryville, where he also earned an MBA.