Although UCLA Health began its formal participation in both federal and commercial ACO programs only last year, the health system has long embraced many of the features considered integral to an ACO’s success.
UCLA has a track record of studying and investing in the patient-centered medical home, documenting positive outcomes associated with the medical home concept through its research as an academic medical center and through specific programs implemented within its hospitals. For example, the Pediatric Medical Home Program at UCLA was established in 2003 to provide coordinated care to pediatric patients with special health care needs. Research related to the program, which is based at Mattel Children’s Hospital UCLA, suggests it has been linked with improved health outcomes, reduced ER visits, improved communication between families and health care providers and increased patient and family satisfaction.
In addition, UCLA Health has invested in a strong primary and specialty care network, which currently comprises more than 80 community-based offices in the Los Angeles area.
UCLA Health was one of the few academic medical centers selected by CMS in January 2013 to participate in the MSSP. Since joining the program, UCLA hospitals have continued to invest in its IT infrastructure. UCLA’s investment in its electronic health record system was acknowledged in December 2013 when three of its hospitals—Ronald Reagan UCLA Medical Center, Resnick Neuropsychiatric Hospital, and UCLA Medical Center, Santa Monica—received HIMSS Analytics’ acute care Stage 7 award. HIMSS Analytics’ Electronic Medical Records Adoption Model uses eight stages (0 to 7) to evaluate a hospital’s implementation and utilization of IT applications. UCLA received a Stage 7 award, indicating an advanced patient record environment, with a system that had been live for only nine months; at the time, only 2.2 percent of the more than 5,400 U.S. hospitals in HIMSS Analytics’ database had received this designation.
In addition to its partnership with CMS as an MSSP participant, UCLA Health has joined the Anthem Blue Cross Enhanced Personal Health Care ACO. As a result, the UCLA Health System stands to benefit not only from the potential shared savings available through the MSSP, but also from the cost-saving initiatives and tools that Anthem is rolling out to its ACO partners.
Anthem’s ACO network was first launched in 2011 as a pilot program. The insurer partnered with Sharp Community Medical Group and Sharp Rees-Stealy Medical Centers to provide care for select Anthem PPO members in San Diego, with an initiative that emphasized coordination of care among all providers and had a dual focus on preventive care and chronic care management. As of July 2014, Anthem’s ACO network included 15 partners in addition to UCLA Health, and Anthem predicted that this number would grow by at least three before the end of the year.
In December 2012, Anthem introduced its LiveHealth Online service, which allows members to choose a doctor and receive live two-way video consultations with physicians for non-emergency needs when their own doctor is not available. The goals of the service are to provide patients with an alternative to ER and urgent care visits, and to alleviate PCP burden. At launch, this service was available only to large local and national employers; it is now available to the majority of Anthem’s customers. Consumers who do not have Anthem coverage can also use the service for a physician fee of $49 per visit.
Notably, UCLA Health’s commercial ACO partner has already begun to report improvements in quality and reductions in cost, and has accomplished this in a PPO population where enrollees have the option to see providers outside of the ACO network. According to Anthem, other ACO programs that document positive outcomes often do so only in an HMO population, which already has coordinated care within a limited network.
In December 2013, Anthem reported that—in the ACO’s first full year of operation—its four medical group partners showed major improvements in quality measures, including a 35 percent increase in the number of mammograms performed and a 44 percent increase in the appropriate prescribing of antibiotics for bronchitis. Through these four partners, 140,000 Anthem PPO members had access to the ACO model of care in 2012.
In June 2014, Anthem reported that its partnership with HealthCare Partners led to a savings of $4.7 million in the first six months of 2013, with reductions in cost driven by an 18 percent reduction in inpatient days, a 4 percent reduction in hospital admissions, a 4 percent reduction in outpatient visits (including ER visits) and a 4 percent reduction in both laboratory and radiology tests. At the same time, the partnership was associated with improvements in measures of quality, including preventive health screenings and management of acute and chronic disease.
Through UCLA Health’s partnership with Anthem, eligible patients may have access to a team that includes their UCLA physician, a clinical pharmacist and multiple care coordinators (in the physician’s office, in rehabilitation facilities and/or in a patient’s home) as part of their PPO plan coverage.
The UCLA Health system consists of the Ronald Reagan UCLA Medical Center; the UCLA Medical Center, Santa Monica; Resnick Neuropsychiatric Hospital at UCLA; Mattel Children’s Hospital UCLA; and the UCLA Medical Group. The health system has a staff of more than 2,000 physicians. The UCLA Medical Center was ranked fifth in the nation and first in California in U.S. New and World Report’s Best Hospitals 2014-2015 Honor Roll.