Page 11 - March 2017

HeartWell’s Outpatient Heart Failure
Accountable Care Options, LLC

Selected to Participate in the Program Reduces Readmission,

Next Generation Accountable Educates Patients

Heart failure is a common disorder among the elderly
Care Organization 2017 Model population, and not uncommon in adults of all ages. Once
diagnosed and treated, with the primary care physician kept
Accountable Care Options, LLC has been apprised of the treatment, the patients are sent home. All
selected to participate in the Centers for too frequently, however, they return to the doctor – or the
Medicare & Medicaid Services’ (CMS’) Next hospital – with recurrence days or weeks later.
Generation ACO Model. In order to combat hospital readmissions, Dr. Jonathan
The federal government is transitioning to Fialkow, managing member of HeartWell LLP has estab-
alternative payment models from traditional, lished a program specifically for heart failure patients,
fee-for-service Medicare payments. CMS is encouraging them to come back to the office to monitor
partnering with experienced ACOs deemed their progress.
ready to assume higher levels of financial risk “Education and communication have a tremendous
and reward. impact in keeping patients healthy,” said Dr. Fialkow. “We Dr. Jonathan Fialkow
“This is the next stage in a new model of find that a large percentage of heart failure patients who
payment for medical care,” said Accountable return should have had their medications modified, needed to be educated about their
Care Options CEO Richard Lucibella. “We condition, or were confused about prescriptions. This program keeps the patients
embrace the model’s challenges and the oppor- Richard Lucibella informed – and calm.”
tunity to produce greater financial rewards for Often, an unstable and decompensated heart creates a myriad of issues, such as in the
the physician practices in our organization.” lungs. A diuretic can resolve the problem. But a patient who is scared and nervous, and
Accountable Care Options has earned financial rewards for its members can’t remember what the doctor has advised, may not take all the medication, and won’t
since it formed in 2013 and joined the Medicare Shared Savings Program. In recall what behavioral changes need to be made.
its first year, physician Shared Savings payments averaged $500 per fee-for- With the outpatient heart failure program, discharged patients come to the office to
service Medicare patient in addition to the practice’s regular Medicare reim- meet with a nurse practitioners who knows their case, and understands their fears – and
bursement; physician practices also achieved a quality score of 100 percent their pathway to health. The nurse meets with the patients, reviews their charts, opti-
from CMS. Accountable Care Options’ Shared Savings totaled $4.4 million in mizes the medical dosage and answers questions they may have in a calm, conversational
2014 and $7.2 million in 2015. setting.
Based on its successes, Accountable Care Options applied this year to the “We want our patients to be self-aware, to understand their symptoms, to maintain a
Next Generation ACO Model, whose “Better, Smarter, Healthier” approach to schedule of medication, and to have access to good medical care on a regular basis,”
improving health care is based on the quality rather than the quantity of added Fialkow.
patient care provided. The Model tests whether strong financial incentives for The program features one-on-one meetings with the nurse practitioner, and can last
ACOs, coupled with tools to support better patient engagement and care several meetings, depending on the stability of the patient. Dr. Fialkow has noted that
management, can improve health outcomes and reduce expenditures for over the four months this program has existed at HeartWell, there is a noticeable decrease
Medicare beneficiaries. in readmissions and a clear improvement in the quality of life of heart failure patients.
“Listening and communicating are as important to heart failure patients as the medi-
cine itself,” Fialkow concludes.

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