It’s been four years since a Buffalo health-care organization launched a Medicaid pilot program designed to reward physicians and providers for cutting costs and improving care and outcomes.
The Greater Buffalo United Accountable Care Organization (GBUACO) remains the region’s only state-designated accountable care organization (ACO), overseeing care for about 30,000 patients across the region insured by government programs through Fidelis and YourCare Health Plan.
GBUACO, an affiliate of the Greater Buffalo United Accountable Healthcare Network, includes participation by providers at Erie County Medical Center, Kaleida Health, Jericho Road Community Health Center, Greater Buffalo Independent Physicians Association, Dent Neurologic Institute and Western New York Medical Group.
Growth for the program is in the works through additional contracts to take care of more patients while saving more money for the state and the overall health-care system.
Dr. Raul Vazquez is CEO of GBUACO and the Urban Family Practice on Buffalo’s West Side. He talked about the challenges and opportunities of making the funding model work.
What makes the ACO model different? It’s the ability of bringing physicians together, both primary care and specialists, with agencies and organizations so that you’re the glue so patients don’t get lost. You’re helping individuals and doing the right assessment, whether it’s social determinants of health or using our digital platform.
What’s your main focus? It is a value-based model. You’re looking at five buckets of cost: inpatient, ER, ancillary, pharmacy and professional costs. What you’re doing with the dollars is looking at how best to look for areas where there’s waste in the system because the patient isn’t being better managed. And for people with chronic diseases, why aren’t we doing better with quality metrics, while also focusing on the prevention side and wellness?
How are you using incentives to prompt participation? We create incentives for (patients) too. Within that high-risk population, how do we push to get those measures and screenings? They get a check. If they get a mammogram, they get $25; if they get a colonoscopy, it’s $25. If their blood pressure is controlled or whether they’re on preventive meds, all these are checklists. It’s a lot cheaper for us to pay $25 for a test than ending up in an intensive-care unit for $25,000. The patient has to be engaged, and has to be a player in this.
What other tools keep patients and physicians involved and informed?We have three apps: one for Urban Family Practice, one for care coordination for GBUAHN and one for GBUACO. They’re used for information, so if they do the test through the apps, they get their dollars for it. Those apps also push out services, including for Covid-19, so they can fill it out if they have symptoms. We now have 1,300 people on the apps.
What outcomes and results are you seeing? The 2019 data is not here yet, but the 2018 data shows that ER visits were reduced 27% from 2016; patient drug and alcohol abuse dropped 12%; and there was a 12% increase in use of generics. That’s a $780,000 savings on the ER side; and $323,000 for inpatient for one year alone. On the pharma side, by increasing generic use, there was a $1.9 million savings.
How realistic is it to expand those programs and savings to commercially insured individuals? If you can do it with government programs, you can expand to everyone else. My love has always been in the city, doing government programs. Not a lot of doctors want to go into those areas, but with the tools we use, they can be applied to anyone in the system.
As the state’s DSRIP program winds down, could you play a role there too? We’re looking at how accountable-care organizations like GBUACO could play a role for that kind of a program long-term. You’re setting a table to bring a lot of organizations together. That can create a more risk-based value-based model. You see where the economy is. You’re going to have to provide services. The best way to do it is to set up a lot of these organizations on one page, as opposed to everyone doing their own thing.
Are there opportunities to expand GBUACO geographically? Now that we have a better feel for the system, with 250 primary-care providers and our contracts including not just Urban and its IPA but also Kaleida, ECMC, General Physician and Jericho, we’re looking at going to the state. We have good support from Crystal Peoples-Stokes (majority leader, state Assembly) and Tim Kennedy (state senator). We’ve talked to their committees about how does GBUACO expand and GBUAHN expand with it? You need the IT informatics piece and the care coordination too.
By Tracey Drury Reporter, Buffalo Business First