St. John Selected to Participate in Second Affordable Care Act Patient Program Focused on Quality
and Cost Savings of Care
TULSA, Okla., July 8, 2014 - St. John Health System reached a new landmark in its effort to provide coordinated medical care at a lower cost with its recent participation as a Centers for Medicare & Medicaid Services (CMS) accountable care organization (ACO). St. John’s ACO, called Oklahoma Health Initiatives, was one of only 123 nationwide selected for a January 2014 start date, and it is the only Oklahoma-based ACO participating in the Oklahoma Shared Savings Program. This follows St. John’s ongoing participation in CMS’ Comprehensive Primary Care Initiative (CPCI) since 2012.
The ACO and CPCI programs are part of CMS’s Innovation Models of payment and delivery systems created under the Affordable Care Act. The Innovation Models are designed to help maintain or improve the quality of care in Medicare, Medicaid and the Children's Health Insurance Program (CHIP), while slowing the rate of growth and program cost.
“Coordination of care, improved service and decreasing overall cost of care are the goals of the CMS Innovation Models programs,” said Robert Kenagy, M.D., St. John Health Network senior vice president. “These are goals with which all physicians can constructively engage.”
St. John’s selection as part of the ACO Medicare Shared Savings Program means it will work with other selected doctors, hospitals and related healthcare providers to give coordinated, high-quality care to Medicare patients. According to CMS, the goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. Since the beginning of the Medicare Shared Savings Program, CMS has approved more than 360 ACOs nationally serving more than 5.3 million Americans with Medicare.
St. John’s Oklahoma Health Initiatives includes a person-centered approach to healthcare, emphasizing prevention and wellness, chronic disease management, and better coordination across the full continuum of care, with every Medicare beneficiary actively involved in his or her care coordination. Oklahoma Health Initiatives will collaborate through shared electronic health records and a physician-driven committee governance structure to improve care for patients and reduce cost trends.
“The models foster an environment where we identify specific short- and long-term needs of our patients,” said Ann Paul, St. John Health System vice president of population health initiatives. “In collaboration with physician partners and community resources, we are able to develop initiatives to meet those needs in a way that positively impacts healthcare outcomes.”
According to CMS, Oklahoma Health Initiatives and other selected ACOs must meet quality standards to ensure savings are achieved through improving care coordination and providing care that is appropriate, safe and timely. CMS evaluates ACO performance using 33 quality measures on patient and caregiver experience of care, care coordination, patient safety, appropriate use of preventive health services and improved care for at-risk populations.
St. John Health System and its St. John Clinic physician group continue to improve the delivery model of primary medical care as a participant in CMS’ CPCI program. CPCI is a four-year, multi-payer demonstration project that focuses on strengthening and supporting primary care with care teams working to improve care systems, reduce variation in care and build clinically integrated care coordination programs.
“The CPCI is focused on transforming the primary care delivery model to one that closely resembles the patient centered medical home concept,” Dr. Kenagy said. “These models facilitate better patient access, improved processes of care, and better overall coordination of care for complex and chronic conditions. CPCI offers us the opportunity to improve the healthcare experience of our patients, while partnering with them to as they make wise choices related to their healthcare. CPCI offers a foundation of teamwork among primary care teams, patients and their families.”
St. John Clinic and other physician practices were selected through a competitive application process based on use of health information technology, ability to demonstrate recognition of advanced primary care delivery by accreditation bodies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size and ownership structure.
Through CPCI, CMS works together with commercial and state health insurance plans and offers prospective payments to primary care physicians who better coordinate care for their patients. Three payers participate in the Tulsa area, including CommunityCare, Blue Cross Blue Shield of Oklahoma and the Oklahoma Health Care Authority.
Oklahoma is one of only seven states selected to participate in the CPCI program. Other site locations include Arkansas, Colorado, New Jersey, New York, Ohio and Oregon.