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.