Maggie McKay (Host): Wouldn't it be ideal if there was a program between hospitals that coordinated patients needs, making Healthcare more efficient for everyone? Well, that does exist. And today, we'll find out more about Jefferson Accountable Care and get an introduction to value-based care and our new ACO with Crystal Eubanks.

Welcome to To Your Health, a podcast from Jefferson Healthcare. I'm Maggie McKay. Jefferson Healthcare has created the Jefferson Accountable Care, or JAC, ACO to participate in CMS's Medicare Shared Savings Program or MSSP.

Accountable care organizations, like JAC, are closely knit networks made up of hospitals, physicians and other healthcare professionals, emphasizing a coordinated approach to Healthcare while reducing unnecessary services and medical errors. Thank you so much for being here, Crystal. Could you tell us about your background and how you got connected with Jefferson Healthcare?

Crystal Eubanks: Thanks, Maggie. Yeah. So, my experience kind of goes back about seven, almost eight years in specifically the value-based care space. I've been from the payer side to the provider side and along different types of models within value-based healthcare, specifically have multiple years experience within kind of the traditional Medicare, MSSP, ACO space. And I was excited to have the opportunity this year to join the Jefferson Healthcare team to really focus on what are our organization's goals and opportunities within value-based healthcare across our patient population.

Host: And what is value-based care and why the move in this direction?

Crystal Eubanks: Yeah. So, value-based care is really a delivery model that's changing the way providers are reimbursed. So, we think about value-based care as a model or concept is what does this transition look like and are the benefits? There's really financial alignment in this type of model, as well as the kind of alignment of goals. So really in value-based care, we're promoting high quality care and paying based on health outcomes instead of the traditional historical fee-for-service model that was really promoting quantity over quality.

In fee-for-service models, it was patient comes in, provider gets paid, patient comes in, provider gets paid. But with value-based healthcare, it's really focusing on what matters most? What are the health outcomes of our patient? What is the experience of the patient? Are they receiving the high quality care that we want to provide them? And when we think of the goals of value-based healthcare, you know, there was a framework that came out roughly 15 years ago at this point called the Triple Aim. And really it was, you know, how do we provide better patient outcomes, improve patient experience while reducing the unnecessary spend.

And then after that, we've kind of adapted and realized that a lot of burden was getting put on our primary care providers and we've shifted to the Quadruple Aim. So, how do we add provider experience as one of those goals that we're working towards? And then, most recently they've expanded to a fifth pillar to come up with the Quintuple Aim. So, that's adding the component of health equity to really our goals. We've come down to, in value-based care, five different pillars we're striving to achieve. Again, better patient outcomes, improving the patient experience, reducing unnecessary spend, improving the provider experience and improving the health equity across our populations.

So in this space, it's, you know, what are the different models that align with value-based healthcare? And then, one we'll talk a little bit more on today is the Medicare Shared Savings Program, which is what we are participating in. Also, when we think of those goals of value-based healthcare, it really aligns with what Jefferson Healthcare is setting out to do as an organization. We want to improve the health of the communities that we serve. We want to deliver the highest quality care. We want to provide the patient experience that we're proud of. So, there's a lot of alignment and goals of what value-based care is seeking to do with what Jefferson Healthcare wants to do for our community.

Host: Crystal, tell us about starting the Jefferson Accountable Care ACO. What was that like?

Crystal Eubanks: So this year, really starting the beginning of 2023, Jefferson Healthcare has decided to start the Jefferson Accountable Care, ACO, and really what the purpose of that is, is to participate in CMS's MSSP or Medicare Shared Savings Program. So, Medicare Shared Savings Program started as an alternative payment model, which kind of sits on top of the fee-for-service model and is a transition into these value-based care models. So, we basically decided to start that this year. So, CMS has a strategic goal of having all of the patients that seek care under CMS, to all of these patients are under an ACO model by 2030.

So as Jefferson Healthcare, we decided not to wait to 2030 to get started in this space. We decided to organize early, gain experience now and really build the program that we want to build that's going to meet the needs of our patients in our community. So, we are kickoff this year of 2023. And right now, we are in the process of building out what our program looks like internally for our providers and what that's going to look like for our patients, building out the teams that we need to be able to add the additional support for our providers and patients. But ultimately, the Medicare Shared Savings Program started just over a decade ago, and CMS is seeing continued results in savings and high-quality performance in this model. So, it's proven successful, we know that this has a positive impact on our patients and the communities. That's one of the reasons we definitely wanted to start our participation. And again, how do we switch from a reactive approach in healthcare to proactive?

And in these ACO models, it allows us to use data of our patient populations, build the support system. How do we take care of patients before they need to go to the hospital? You know, how do we get in front of those things so our patients ultimately will see better health outcomes? I mean, our providers are working hard to take the best possible care of their patients, and then how do we help them to support those activities, and that really switches over to a team-based approach to healthcare, which is really what we're building, is really trying to build that comprehensive support system for our patients and our providers to really provide the best possible, you know, healthcare and wellness for our patients and community.

And when I think of the ACO programs in general and these types of value-based care models, it's kind of a cyclical approach or outcomes, if you will. You know, If we can build the infrastructure to have these additional resources and support mechanisms for our patients, then they're ultimately going to see better outcomes and a better experience. That then typically is going to reduce unnecessary spend, potentially reduce unnecessary hospitalizations, which then provides success in these alternative payment models. And then, that comes back around to providing additional funding, so then we can again help build our infrastructure and maintain the infrastructure to provide these additional programs and resources. So, that's really in the ACO space. Again, it all comes down to those key goals. You know, how do we provide the best possible care for our patients?

Host: Right. And you mentioned impacting the patients. How so? How does all that impact the patient in the end?

Crystal Eubanks: Yeah. So again, I think it really comes down to building out this team-based care approach and this multidisciplinary team to help extend the arm of our primary care providers. And primary care, you know, doctors and physicians, as much as we'd like them to be in 10 places at once, we know that's not possible. So, I think one thing we think about impacting our patients is how do we provide extra resources for them?

I think one thing that's important is we think of the ACO's impact to patients is it does not change their benefits, it doesn't dictate what providers they see. That's still between the choice of the patient. But this team-based care approach is adding additional support mechanisms for our patients. For example, you know, a patient that just gets out of the hospital, would they benefit from a phone call from a nurse one, two, three days after that discharge to make sure that they receive the medical equipment they needed after discharge, or they don't have any questions about the medications they're supposed to be on, or helping them get coordinated back to scheduling with their primary care doctor within a couple weeks of discharge, or we also think of kind of the impact to patients in a way of, you know, not every patient's the same. So when we think of our goals of better outcomes and better health for our patients, that bar can be different per patient. One patient's goals are not the same as another's. You know, one patient's goals may be, "I want to go out and hike a mountain in a month," or one may just want to say, "I want to be able to go play with my grandchildren." So, we need to meet the patients where they are and we need to support them to meet the goals that they're looking to achieve.

Another thing when you think of the patient impact is how do we help our patients with multiple chronic conditions? So, patient A might be a healthy patient. They come in once a year for an annual checkup, maybe come in a couple other times, you know, for sick visits and they're good to go, but that's not the same for all of our patients. There's going to be a section of the patients that have multiple chronic conditions. Maybe they have diabetes, COPD, congestive heart failure, and they're trying to manage all those different conditions while on top of maybe having transportation challenges. And they can't get in to see their doctor as often as they want. So, how do we help the patient and the providers again? It really comes down to additional support, additional resources to be able to provide the highest quality of care for our patients so that they will see the better outcomes and experience.

Host: It sounds like a win-win all the way around.

Crystal Eubanks: Yeah, that's really the goal of it.

Host: Yeah, well just in closing, Crystal, what's in store for the future?

Crystal Eubanks: So, it really comes down to building out that team. Like I mentioned, we're in our first year of the ACO that we started. As much as I'd like to say, "Hey, this team's ready to go right now and we built it all out," we're in the process of designing what the program looks like internally. What meets the needs of our patients, the needs of our providers, so as much as I want to say, I know exactly what it's going to look like a year from now, five years from now, those things also may change. But really wanting to have a full multidisciplinary team to support our patients and providers, that's definitely the goal of where we're going with this. We, again, want to build it in a way that benefits our community and our population. And if we're successful in this, then again, it helps provide the funding back to add in additional resources. But it comes back to those original goals that I mentioned, better patient outcomes and providing the better experience for our patients. How do we do that? We build this team, we come to a patient-centered approach, a team-based care approach, and we all work together to meet our patients where they are to make sure they're having great outcomes and a great experience.

Host: That sounds really reassuring, especially if you're the patient. Crystal, this has been so informative. Thank you so much for sharing your expertise.

Crystal Eubanks: Thank you, Maggie. I appreciate it.

Host: That's Crystal Eubanks. And if you'd like to find out more, please visit jeffersonhealthcare.org/about-us/medicare-aco. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is To Your Health, a podcast from Jefferson Healthcare.