In today’s health care landscape, the shift from traditional fee-for-service models to value-based care (VBC) is gaining momentum.
St. Luke’s University Health Network (SLUHN), a nationally recognized nonprofit health care network in Bethlehem, Pa., is a leader in VBC that achieved a major milestone by becoming the region’s only health network to significantly reduce costs. The health system shared $38 million in savings with the Centers for Medicare and Medicaid Services as a reward for controlling costs while providing the highest possible quality medical care to Medicare patients in 2022.
“Our top priority at St. Luke’s is to improve the well-being of all patients inclusive of our Medicare beneficiaries while reducing the costs associated with their care,” said Donna Sabol, senior vice president and chief quality officer at SLUHN. “We are pleased that our organization has successfully showcased how accountable care models can expedite this journey and turn our objective into a concrete reality.”
SLUHN formed an accountable care organization (ACO) in 2018, which today includes roughly 2,000 physicians and advanced practitioners, employed by both SLUHN and independent community offices. The ACO serves 45,000 Medicare patients who selected participating primary care physicians.
A strategic partnership with leading health care improvement company and association corporate affiliate member Premier Inc. helped SLUHN achieve success in several areas:
Advancing Hierarchical Condition Category (HCC) Coding Processes
SLUHN successfully improved health care quality and costs through an initiative focused on HCC coding and clinical documentation using Premier’s advanced HCC analytics solution.
HCC coding is crucial for estimating future health care costs and ensuring appropriate reimbursement for Medicare Advantage plan patients. SLUHN leveraged the artificial intelligence – enabled solution to enhance coding accuracy by analyzing patient data, identifying potential risk factors, and suggesting appropriate codes, thus streamlining the coding workflow.
Health system leaders engaged specialists in the HCC capture process and followed three key strategies: defining specialists’ roles, providing HCC education, and offering coding support. As a result, SLUHN increased its risk adjustment factor scores, becoming a top regional performer, with significant improvement seen in nephrology specialists due to focused analytics.
Reducing Clinical Variation and Improving Quality
SLUHN recognizes the importance of reducing clinical variation in health care delivery. The health system implemented Premier’s INsights analytics solution to access and analyze data efficiently.
This technology provided benchmarks for comparison and empowered health care leaders to make informed decisions across various functions. Collaboration among data analytics teams, transparent data sharing, and physician engagement were crucial for success.
By making accurate, actionable data accessible throughout the organization, SLUHN reduced clinical variation and received Leapfrog Group A ratings across all hospitals. Additionally, the 100 Top Hospitals® program, which helps health systems identify opportunities for performance improvement, recognized SLUHN as a 15 top health care system in 2022. SLUHN has been recognized 11 times as a 100 Top Hospital®.
Transparent, actionable data and benchmarks allow providers to examine performance holistically and implement plans for quality, operational, and patient safety improvement efforts. By analyzing what institutions do exceptionally well, other providers can identify best practices and strategies to emulate or adopt in their own settings.
Streamlining Breast Cancer Diagnosis and Care
SLUHN partnered with GE Healthcare and Premier’s Applied Sciences team to implement the groundbreaking One-Stop Clinic™ (OSC) for Breast to expedite breast cancer diagnosis.
OSC is a comprehensive approach that streamlines the patient journey from initial appointment through diagnosis and treatment planning, all in one location with a dedicated team.
The OSC approach reduced the diagnosis time from a national average of 26 days to approximately 48 hours or less. St. Luke’s achieved this remarkable success, with 100 percent of patients diagnosed within 48 hours by September 2022. Customizations, including contrast-enhanced mammography and patient-controlled breast compression, further improved the process.
Final Thoughts
SLUHN remains at the forefront of health care innovation, actively leveraging the right data and technology and participating in forward-thinking VBC initiatives. The system’s impressive outcomes underscore the value of the ACO model, illustrating that providers with the appropriate strategy, tools, and incentives, can enhance patient care and lower costs.
“St. Luke’s is dedicated to providing care for those in need, improving the overall health of our communities and educating our health care professionals,” Sabol said. “Our collaboration with Premier has empowered us to develop innovative ideas that promote patient-centered care and better educate our providers and communities.”
SLUHN’s VBC journey demonstrates the multitude of diverse approaches to population health management. Ultimately, health care organizations have the power to shape their own VBC future.
Learn more about solutions that can help your organization drive performance improvement, enhance clinical care, and achieve Medicare Shared Savings Program success.
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