UH Committed to Leading on Value in Health Care
November 02, 2021
Evidence seen in our recent success in the Medicare Shared Savings Program
By Cliff Megerian, MD, Chief Executive Officer, University Hospitals
UH Clinical Update | November 2021
University Hospitals has been engaged for many years in a mission to not only offer excellence to each patient, but to also take care of large populations of patients, and keep them healthy.
One way we do this is through the Centers for Medicare and Medicaid Services (CMS) and its Medicare Shared Savings Program (MSSP), in which we participate.
So here is some tremendous news: For the second year in a row, we have received a significant amount of shared savings - $8.8 million for 2020.
Before I get into the details of how we performed in the management of our nearly 60,000 Medicare patient-lives, I want to touch on an important point, one you’ve heard from me since I’ve come into my new role as CEO.
And that concerns the way UH differentiates itself in four areas.
The first is that we are the provider of the kindest, most compassionate and personalized care. The second is that we are a champion of value, which means offering the highest-quality health care at the lowest cost. Third is that we are the best provider of practical scientific breakthroughs and discoveries, as we showed when the COVID-19 pandemic took hold here. And fourth, we are the hometown health care system that is dedicated to this region, and this region only.
I’d like to provide some insight into how the 2020 CMS data, which was just released, is very encouraging as to our long-term success and indicative of our ability to deliver on differentiator No. 2, which is to be the best provider of value as it relates to highest quality and lowest cost.
Some background: The MSSP is a voluntary accountable care organization in which hospitals or individual practice units from around the country can agree to participate. The goal is that we provide high quality while demonstrating that we can lower costs by reducing unnecessary care – for example, by preventing the need for a hospital patient’s re-admission, and for unnecessary services.
So each year, CMS reports on nearly 513 ACOs in the U.S. Of those 513, I am very pleased to report to you that only 71 achieved a 100 percent score for 2020, and UH was one of those. This is up from 97.4 percent in 2019 and 73.4 percent in 2018
Based on the hard work of our Primary Care Institute, our ACO and Dr. Peter Pronovost and his team, the UH Coordinated Care Organization (UHCCO), which is our system’s Medicare Accountable Care Organization, UH had the fourth-lowest cost in the nation - $8,286 per member – which is the best in the state of Ohio.
Two years ago, our cost was $10,500 per person per year - more than $2,000 higher than our current performance. With our focused efforts toward the goal of zero harm, we are improving each year.
This shows how we can provide the highest quality while also bending the national curve of escalating health care costs.
We have become a leader in lowering costs.
We do this not by limiting care or withholding necessary care, but by keeping healthy people out of the hospital when they don’t need to be there, and out of the ED when they need to be taken care of by their primary care physician or an urgent care center.
It also means limiting unnecessary testing that everyone agrees should not be done in a particular circumstance, and it requires us to ensure that everyone who is hospitalized follows up quickly with their primary care doctor to prevent readmission.
What underlies these efforts at UH, as Dr. Pronovost, our Chief Quality and Transformation Officer, explains: “This is a testament to all our caregivers for their increased focus on keeping patients healthy at home, rather than healing in a hospital. We continue to follow through on our strong commitment to be leaders in value – we aligned the entire organization around value, made defects in value visible and designed systems to reduce those defects.”
I believe the entire UH system, and every employee, deserves tremendous congratulations. Every one of us plays a part, no matter how we touch the patient. We want patients to have a sense of trust and belonging that gives them a sense of relief – because they know that if they are in our care, we will make the recommendations that keep them healthy while avoiding unnecessary or duplicative interventions.
To be one of the Top 4 quality providers in the U.S. by CMS measure is a reason to celebrate.