Medicare Shared Savings Program (MSSP): Track 1 ACO
As the name implies, an accountable care organization (ACO) is held
accountable for the quality, cost, and care experience of an assigned
population. Through CMS’s multi-track Medicare Shared Savings Program (MSSP)
participants nationwide explored the ACO model with Medicare fee-for-service
beneficiaries. In Track One, ACOs share savings but don’t incur losses.
Here are two examples.
Crystal Run: Data Accelerates Progress
Physician-owned multispecialty medical group Crystal Run Healthcare was one
of the first participants in the MSSP program, joining in 2012 as one important
step in its overall journey from volume to value. In AMGA’s webinar series,
Chief Quality Officer Scott Hines advised AMGA members to prioritize data and be
proactive about making the change from volume to value. “Don’t wait for the
market to move and then catch up,” said Hines. “Be a leader in your market
because there is a first mover advantage, particularly if risk-based contracts
benchmark you in the market.”
By mining claims information, Crystal Run identified three major cost
centers: acute and subacute rehabilitation, admissions and readmissions, and
overuse of specialists and labs. With these insights sharpening its focus,
Crystal Run reconciled in-home medications for the sickest patients, which
reduced hospital readmissions, and educated primary providers about the
unnecessary use of specialist and labs. In addition, they had patients go to
physical therapy prior to surgery to increase strength and flexibility for
easier post-op recovery.
With multiple quality measures to report, finite windows of time to do so,
and the ever-present possibility of a CMS audit, robust information management
is critical to MSSP success. Crystal Run got ahead of the situation by writing
the code for data collection over nine months in advance. The organization
had the foundation to do so, as an early adopter (since 1999) of electronic
health records and the first New York practice to achieve Joint Commission
accreditation. Since Performance Year 1 (PY1) pays for reporting, as long as a
group reports data accurately and completely, it will get full credit regardless
of their performance. Hines suggests that groups use PY1 to grow their
capabilities to perform well on the measures, since PY2 and beyond are pay for
performance, and it takes time to build those competencies.
Involving physicians and IT specialists in the effort was key. “It was
important to have providers show the business intelligence team where to look in
the chart,” Hines said.
Memorial Hermann: Care Integration Delivers Powerful Results
With an estimated 323,000 lives covered by its ACO, Memorial Hermann Health
System reported nearly millions in savings in per-employee, per-year claims
costs over four years. Meanwhile, its rates for avoidable ER visits and
readmissions fell below the averages for the Houston market where the
D. Keith Fernandez, Memorial Hermann’s then president, physician in chief,
and CMO, credited much of this success to clinical integration.
“Physicians must be integrated on a clinical basis to determine and commit to
the right and best ways to practice medicine, commit to mutual accountability,
and develop active performance improvement programs to enhance healthcare
quality and efficiency,” Fernandez told AMGA members.
As an MSSP participant, Memorial Hermann segmented patients by risk and
delivered care based on matching intensity levels: from wellness and prevention
programs for healthy patients to chronic disease management, telemedicine, and
home visits for the smaller number of sickest (but most costly) patients.
MSSP participation has laid the groundwork for future transformation, he
said. “Clinical integration provides the foundation for risk-based contracting,
population health management, and an ACO within a hospital or hospital system.”
It’s a necessary journey for Texas’ largest not-for-profit health system.
“Employers are bearing more risk, turning to providers as allies. They want a
reliable product with predictable and stable costs.”
AMGA: Your Partner for Value-Based Care. Contact
Bill Baron, 703.838.0033 ext. 336 to take
the next step.