Monthly Archives: December 2014

What Could the Proposed MSSP Rules Changes Mean for ACOs

Post by Brian Drozdowicz

Senior Vice President of Population Health, Caradigm

2014 was another year of learning for ACOs participating in the Medicare Shared Savings Program (MSSP). So far, the results have been uneven, as three out of four ACOs launched in 2012 and 2013 did not save enough to earn bonuses. Only five out of more than 300 ACOs felt confident enough to choose the option for a penalty and increased shared savings. The National Association of ACOs surveyed MSSP ACOs in October and found two-thirds were somewhat or highly unlikely to continue if they were required to accept penalties. Finally, on the Pioneer ACO program side, eight of the nine ACOs that left the program posted losses for the first performance year, and none of them earned shared savings.  

Given these results, many ACOs are understandably in agreement that they would like more time to acquire the infrastructure and expertise needed to revamp their models of care. In response to this feedback, the Center for Medicare & Medicaid Services (CMS) is proposing changes to encourage providers to stay in the program. A number of publications including Modern Health and Becker’s Hospital Review have posted good summaries about the proposed changes. I believe the key aspect of the proposed changes is that it would lessen the risk ACOs face in the short term while they gain traction in the program.

Clif Gaus, CEO of the National Association of ACOs, supports the extra time for ACOs because he said “It’s probably a decade-long process to redesign all of the care processes that lead to both better care and more appropriate care…There’s a big learning curve for many ACOs. They are almost new businesses starting from scratch.”

The proposed changes would create a much needed buffer, however, it’s also important for ACOs to realize that 2015 is the year they should accomplish the identification and implementation of technology needed to drive population health management and more shared savings. I found it interesting that CMS is also proposing to add new eligibility requirements to the program that will ask applicants to describe how they will promote the use of enabling technologies for improving care coordination as well as provide milestones and targets for the implementation of those technologies. This shows CMS has acknowledged the critical role that technology plays in the shift to population health although it is still a long ways away from making any specific recommendations.

Given our work with a variety of customers managing these challenges, I am more than willing to make recommendations about the various capabilities required to successfully support the transition to value based care and am passionate about helping others take that step. One of the most important things to focus on is to take a holistic technology approach that considers the entire organization – an enterprise population health approach. A narrow approach using point solutions can fall short because population health requires integrated technology to bring together data, analytics and workflows across the entire organization. For example, the technology requirements of a population health strategy are:

  • Aggregation, normalization and sharing of all of your data (e.g. clinical, claims, financial) in near real-time
  • Application of analytics to all of the data to stratify your population, uncover insights and enroll patients in programs  
  • Surfacing of the data, analytics and insights at the point-of-care (i.e. within care management workflows and EMRs) to make care more efficient and consistent for the targeted population

A gap in any of these requirements or a lack of integration between them creates inefficiencies that become a blocker to overall population health efforts. When there are synergies and automation between a platform, applications and workflows, that’s when tremendous efficiencies and improvements can be realized. This innovation is real, and Caradigm is the leading provider in the market delivering a comprehensive solution that enables enterprise population health. I’m anticipating that 2015 will be a pivotal year for ACOs as many adopt the technologies and strategies they will need to thrive. If you’d like to continue the discussion and learn more, send a note via this form.

DSRIP Leads to Population Health Management

Post by Vicki Harter, BA, RRT

Vice President, Care Transformation

It’s challenging to provide care for the patients most in-need – the homeless, those with untreated, chronic health and mental illness. These patients often lack consistent primary care, and often only receive treatment when they go to the emergency room during an acute episode. It’s a lose-lose situation because the patients don’t sustain the improved health after leaving the ER, and costs are unsustainable for providers and U.S. taxpayers.  

The federal government saw the need for better coordinated care of Medicaid and uninsured patients, resulting in the creation of the Delivery System Reform Incentive Payment (DSRIP) program to help healthcare organizations transform how they deliver care to those patients. At its highest level, DSRIP is intended to advance the Institute for Healthcare Improvement “Triple Aim” of improving the health of the population, enhancing the experience and outcomes of the patient and reducing the per capita cost of care. DSRIP is also ultimately about Medicaid reform, moving to a system of care that promotes wellness rather than just manage sickness and promotes value of care over volume of care.

DSRIP points people in the right direction by emphasizing certain goals such as the “Triple Aim,” collaboration with community providers, avoiding preventable hospitalizations and clinical improvement for chronic diseases. What DSRIP does not do is specify how providers are going to accomplish those goals, which requires organizational change and new technologies. To complete the picture, healthcare organizations need a population health management strategy and solutions to enable that strategy.

Population health management solutions can reduce silos of care by sharing data and analytics across the community at the point-of-care. Patients are given a single plan of care focused on prevention and wellness that is then executed by a care team across the continuum efficiently and without redundancy. The result is an integrated community of providers that delivers better coordinated care to make patients healthier and keep them out of the ER and hospital settings.

The DSRIP program represents a great opportunity for eligible organizations to jumpstart a population health strategy. To learn more about the DSRIP program, you can watch this short video or contact us to discuss further.