Reducing the Cost of Care in the Commonwealth

| Posted On Jan 22, 2016 | By:

The cost of quality health care is a significant issue for people across the Commonwealth. Atrius Health has long been committed to providing the highest quality patient-centered care while actively bringing down the cost of care for our patients, their families, and our communities. On January 20th, the Massachusetts Health Policy Commission (HPC) released a special report on price variation which identified Atrius Health as a highly paid physician group.

While we thank the Health Policy Commission for their efforts to shed light on opportunities to contain growing healthcare costs, we believe the HPC’s focus on “Relative Pricing” does not tell the whole story in determining how to best bring down costs. The right measure of a provider’s effectiveness is Total Medical Expense (TME) which captures both price and the cost of total healthcare services utilized. The HPC’s measure of “Price” does not capture prevention, avoiding over-utilization of expensive services such as repetitive and unnecessary hospital and emergency room visits or extended stays in skilled nursing facilities, and failure to treat behavioral health issues.

At Atrius Health, we have developed programs and services that:

Our results are impressive. For Medicaid managed care patients, we have demonstrated 39% fewer medical admissions to the hospital and 37% fewer emergency room visits than the health plan’s network. Similarly, for one commercial health plan we have demonstrated a 30-day readmission rate that is half of the network rate and 25% fewer emergency visits than the network; for another commercial plan we have 8% fewer hospital admits than the average. Our best practices in these areas demonstrate that we can help people be healthier and bring down the total cost of care at the same time.

Atrius Health is closely aligned with the HPC, the health plans, employers, and policymakers who are working to reduce the cost of care. We are a unique entity in our market as a very large non-profit physicians’ practice with a home health and hospice agency that is independent of any hospital system and often able to provide care to our patients at home or in an office setting with no facility fees. Furthermore, our longstanding commitment to alternative payment methods means we take full responsibility for the total cost of the care for our patients. In fact, the prices that the HPC has pointed out in their report reflect that the payers recognize and place a premium on our model of care precisely because we have demonstrated that our model results in an overall lower total cost. By using fewer expensive services to keep our patients healthy, Atrius Health is at or below market average in Total Medical Expense with almost all payers, including commercial, Medicare, and Medicaid health plans.

Our patients benefit because, in the cost of a visit, they receive many services that help them keep their overall cost low. Atrius Health is a “Tier One” provider; i.e the least expensive co-pay, with almost all of the tiered health plan products. And our work to reduce cost lowers overall premiums.

We are proud of the work that we do and the care we provide at Atrius Health. We are always focused on improving the health of our patients and ensuring the value of our care. And, our quality scores and patient satisfaction numbers tell us we have been extremely successful in doing do.

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  1. Can you share any data which depicts Atrius performance versus network on the TME scorecard, eg from the BC/BS commercial population, or the Pioneer Medicare cohort? Mike Kelleher MD

    Comment by Michael Kelleher MD on January 22, 2016 at 10:13 am
  2. For Pioneer ACO, Atrius Health has the lowest budget of the 5 Massachusetts ACO’s, in some cases by as much as 20% or more.
    A local commercial HMO 2014 TME performance is 98%, or 2% below their network A national PPO 2014 TME performance for PPO patients is 88%, or 12 % below their network

    Comment by Atrius Health on January 26, 2016 at 9:08 am

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