Advocate’s Dr. Gary Stuck on His Health System’s Sustained ACO Success

When officials at the federal Centers for Medicare & Medicaid Services (CMS) announced the 2022 performance results for the accountable care organizations (ACOs) participating in the agency’s Medicare Shared Savings Program (MSSP) on Aug. 24, they were able to celebrate some real gains for the program. As the press release posted to the agency’s website on that day noted, “The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program saved money for Medicare while continuing to support high-quality care. Specifically, the program saved Medicare $1.8 billion in 2022 compared to spending targets for the year. This marks the sixth consecutive year the program has generated overall savings and high-quality performance results. This represents the second-highest annual savings accrued for Medicare since the program’s inception more than ten years ago,” officials noted.

And the press release quoted Xavier Becerra, Secretary of Health and Human Services, as stating that “This program has delivered more than $1.8 billion in savings and delivered high-quality health care to millions of people. Just last month, we proposed ways to further grow and expand this successful program, especially in rural and other underserved communities. The Biden-Harris Administration will continue to do everything we can to strengthen Medicare and ensure everyone can access high-quality, affordable health care.”

And, below that marquee-highlight statistic of $1.8 billion in savings, a number of hospitals and integrated health systems were able to boast about really excellent outcomes. Among the patient care organizations with the strongest results in FY 2022 was Advocate Health, the third-largest U.S. not-for-profit health system, created from the combination of Advocate Aurora Health and Atrium Health, and operating under the names Advocate Health Care in Illinois, Atrium Health in the Carolinas, Georgia and Alabama, and Aurora Health Care in Wisconsin. The health system, with its lead corporate office in Charlotte, encompasses 150,000 team members across 67 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs.

What’s more, prior to the merger of the organizations that make it up, both Atrium and Advocate Aurora Health had been inaugural participants in the MSSP, when that program began in 2012.

The integrated health system’s Aug. 31 press release on its accomplishments began thus: “The latest data from the Centers for Medicare and Medicaid Services show that Advocate Health’s affiliated accountable care organizations generated $128.2 million in total savings through the Medicare Shared Savings Program in 2022, the most in the country among integrated delivery networks. The ACOs have saved taxpayers more than three quarters of a billion dollars since they first joined MSSP in 2012, consistently meeting benchmarks for providing high-quality care while lowering costs. The results reflect Advocate Health’s early success in delivering on the system’s pledges to improve affordability and elevate clinical pre-eminence and safety, as well as the determination of hardworking providers and teammates across the enterprise to continually innovate and deliver highly coordinated care.”

“Advocate Health will continue to build on these tremendous results to transform healthcare for the better and make care more affordable and accessible to our patients,” Advocate Health CEO Eugene A. Woods said in a statement contained in the press release. “We are proud of the ways we are saving taxpayers and patients money and leading the way on value-based care.”

The press release went on to state that “The system attributes its performance to the hard work of its physicians, advanced practice providers and nurses, supported by a best-in-class network of care managers, social workers, pharmacists and other health care professionals. They all work together to help patients manage their chronic conditions by staying in regular touch with patients and their families. These experts help people overcome barriers that might prevent access to medications, specialty visits or other care that they need, and serve as a support network as patients take steps to make healthy lifestyle changes.”

And Advocate Health CEO Jim Skogsbergh was quoted in the press release as stating that “Relentlessly closing care gaps and managing chronic conditions helped keep our patients out of the hospital, leading to both more healthy days with their families and overall cost savings. Thank you to our physicians, nurses and teammates, whose expertise and commitment make a meaningful difference in our patients’ quality of life,” he added.

Recently, Gary Stuck, D.O., chief medical officer at Advocate Health, sat down with Healthcare Innovation Editor-in-Chief Mark Hagland to discuss the exceptional performance of the Advocate MSSP ACOs last year, and ongoing. Below are excerpts from that interview.

Having participated in the MSSP since 2012, what have you and your fellow Advocate leaders been learning, collectively?

We’ve learned a few things. Number one, you have to be very serious about your commitment to value-based care. It can’t be a “side hustle.” You have to make investments in your people, the technology, the infrastructure, and constantly reinvest. And it does take a culture change. We’ve had the opportunity to transform our care through innovative models, creating outreach, and enabling ourselves through our technologies.

Our visionary CEOs, Jim Skogsbergh and Gene Woods, have been champions for value-based care. And we’ve made pledges to our patients and communities around top outcomes, as well as affordability, and we also have a pledge around health equity. These transformational, value-based programs offer us the chance to really deliver for your patients.

One element that some ACO leaders contend is that the benchmarks are set up in a way that makes it progressively more difficult to show high levels of performance. Your thoughts on that?

It’s true that the benchmarks are set up in a way that makes it progressively more difficult; but you can succeed if you’re relentless in pursuing your goals. You just have to have that relentless focus in improving care for your patients. And you have to make relentless investments on behalf of your patients. As I said a moment ago, it can’t be a “side hustle.” And you’ve got to engage your clinicians.

How have you, year over year, created a physician culture that gets everyone rowing in the same direction?

Physicians went into medicine to deliver really good-quality care. And we do have physician leaders who step up, and that leadership is critical; not everybody gets it immediately. When the physicians work together to transform care and even payment models—when they find success, they really get engaged. So we work to promote physician empowerment. And physicians are naturally competitive people; and transparency really helps promote success. You really want to wear the team jersey of the winning team. And it’s everyone, not just physicians, but advanced practice nurses, pharmacists, everyone. Every has to be all in.

Can you share a few marquee numbers around performance?

We’ve collectively achieved $761.5 million in savings since joining the program in 2012. This breaks down to $600.6 million and a 92.5-percent quality score in the Midwest, and $160.9 million and a 94.2-percent quality score in the Southeast. Additionally, we have reduced key utilization rates against our benchmark year baselines with a 9.7-percent average reduction in acute hospitalizations, 7.2-percent reduction in ED visits, and 10.3-percent reduction in SNF skilled nursing facility] stays.

How have you achieved such savings and such high quality scores?

We’ve really been focusing on transitions of care. Making sure medications are lined up properly, and focusing on avoidable admissions and readmissions: those are key drivers of quality and of lowering cost. Patients are caught in the middle; we need to help them navigate a difficult health system and have to make it easier for them to navigate the system. We’ve avoided unnecessary skilled nursing facility admissions. And patients want to be at home with their loved ones and pets. So we try to create a care model for them to help them stay at home as much as possible.

Are you developing hospital-at-home programs?

We have hospital-at-home programs in both regions. And we’re looking to use them for conditions such as congestive heart failure, lung disease [COPD] , etc. It’s a great patient and family satisfier as a program. And some of the technologies we’re building out are to really optimize care in the home.

Can you speak to what everyone has been saying, that mastering data analytics is an absolute critical success factor?

Yes, it absolutely is; if you’re not data-driven, you won’t get the quality outcomes or bend the cost curve. We rely heavily on data to determine the who, what, where, to have patients cared for in the right settings, and to determine where we’re succeeding, and where we’re finding gaps. Data is foundational to the work that we do.

What might the next few years look like for your organizations?

We’re grateful for these programs, because they help us transform the healthcare system. And we’re very excited about our entrance into ACO REACH. It really focuses on patients with health equity care gaps. So we’re also in ACO REACH now.

So we actually have two programs, one in the southeast region, one in the Midwest, with ACO REACH. We need to continue to transform care as a healthcare system. We need to look at gaps—it might be the social drivers of health, or around medications. We have to learn what’s working and what isn’t, to drive success in the ACO REACH program. So it’s a very exciting for us.

What advice might you be able to share with leaders at other patient care organizations who might want to follow in your footsteps?

This hard work really does take leadership and culture, and there has to be a relentless focus on the work. There are so many distractions: we just went through the COVID pandemic, and health systems are financially constrained everywhere. My advice is, making a commitment, and lean into the culture change, don’t be reactive. We know our healthcare system is too expensive and doesn’t provide the outcomes.

And you’re continuing your commitment to this innovative work despite the financial challenges, correct?

Yes, we’ve had many, many challenges, just like every other health system, but it’s all about leadership—consistent, visionary leadership.