The ACO Strategy for the City and County of San Francisco
Our participation in the City and County of San Francisco ACO illustrates how collaboration, connectivity and unique care management programs makes Brown & Toland an ideal ACO partner.
We structured our collaboration with Blue Shield and CPMC to:
- Target and implement care management programs using predictive analytics and evidence-based protocols to lower hospital admissions, length of stay, emergency room utilization and boost generic drug prescribing.
- Share clinical and case management information real-time, re-engineering and coordinating clinical work processes
- Coordinate with primary care physicians to reach out to patients for preventive screenings
- Establish programs to track success and care quality
- Align financial incentives and risk-sharing
Among the specific strategies employed:
- Real-time connectivity between Brown &Toland’s care management team and CPMC’s care management and emergency room systems.
- Brown & Toland’s care managers were placed in CPMC’s acute care facilities to coordinate care post-discharge and follow-up with patient to ensure medications were filled, follow-up care scheduled and questions answered.
- Complex case management and chronic disease management services were provided for the highest risk patients.
- Daily coordination of care between CPMC hospitalists and the Brown &Toland care management team for each patient admitted to hospital.
Our superior care coordination resulted in improved health outcomes, a better patient experience and lower healthcare costs for the City and County of San Francisco.