Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released the 2016 shared savings results for the Pioneer and Next Generation (Next Gen) accountable care organizations (ACOs). In addition, the National Association of ACOs (NAACOS) released the findings of its annual survey. The results give us hope that this whole “let’s work together to make it better” attitude might just actually work, but we must evaluate the findings a little deeper to better understand correlations between the results and where ACOs need to focus to be successful in value-based risk arrangements.
While CMS did not post the quality results for the Next Gen program participants, it is likely that a few did not have good insight to their financial performance as they must share in losses. CMS did publish the overall quality score for the Pioneer program participants. Most notably, a couple of Pioneer ACOs that did not receive shared savings had outperformed many of their counterparts in quality. As a case in point, Partners Healthcare ranked 3rd with an overall quality score of 94.51% and while it appears that they did not generate losses, they may not have met the minimum savings rate (MSR) required to share in savings. Michigan Pioneer, on the other hand, had the lowest overall quality score, though still commendable, at 88.93% and achieved a shared savings of almost $7.5M! These are impressive results and give optimism to others that are on the cusp. An interesting statement from the introduction of the NAACOS survey:
“Overall, we found that a large number of ACOs are currently considering or have firm plans to participate in future risk-based contracts (47 percent planning for shared savings/shared risk and 38 percent planning for capitation), although care management strategies are largely unchanged. This and the data below suggest that ACOs are slowly becoming willing to accept increased financial risk, but they are largely still learning how to actually manage populations.”
Many organizations spend years focused on building governance, engaging physicians, and talking about what to do – what they fail to or wait too long to focus on are the key items for which they will be measured. I understand that gaining buy-in and establishing governance are important when you’re first putting an ACO together, but the CMS shared savings results illustrate why ACOs must focus on two additional core tenets to help drive their success – analytics and improved care management strategies. A few tips to help you advance your analytics and care management efforts are outlined below.
- KNOW YOUR NUMBERS
Successful ACOs have acquired and adopted some sort of analytics technology, but those that are most successful identify IT systems that are able to provide insight across three domains: 1) population risk, 2) quality measure, and 3) cost. ACOs must evaluate their current data analytics capabilities, identify any gaps, and determine the best approach to resolving these gaps. In some instances, an organization may choose to implement a new enterprise platform; in others, it may be most efficient to integrate a solution to fill the need. Regardless of the system architecture approach, for a complete view of the population’s health an organization must have the following analytic capabilities:
- Risk stratification – This type of system will integrate an industry-accepted risk adjustment scoring methodology that will stratify the entire population, while also providing additional data points for analysis. Ideally, the system allows the user to electronically assign these patients to care management for intervention.
- Clinical quality measures – A clinical quality measures system will provide insight to performance at the quality program level (e.g., HEDIS, CPC+, MIPS, etc.). The system must allow drill down through the measure into the practice, to the provider, and to the patient level. As patients with gaps in care or measure compliance issues are identified, the system should allow the patient to be electronically transitioned into care management.
- Financial and utilization insights – These systems provide analytic views of integrated clinical and claims data to reveal, in real time, utilization patterns across populations, care settings, networks, and payers. Systems that can track and trend utilization and cost information, including drill down to the per member per month, is key. As with the other systems above, the user should be able to electronically forward patients directly into a care management system.
The capabilities of population health analytics tools have grown significantly over the past several years. ACOs and other clinically integrated networks, as well, have a tremendous opportunity to position themselves for success by securing the tools and systems that will equip them with the information and insights needed to manage their patient population. Failure to leverage the power of a complete view (including cost and quality data) analytics platform will have a detrimental impact on an ACO in a risk-based arrangement because they may succeed in quality but not have visibility to their costs and vice versa.
- SUPPORT CARE MANAGEMENT
Organizations that are thinking ahead will select an analytics system that enables users to electronically send patients identified for care management during the analytics process directly to a care management system. ACOs must have the proper tools to support care management activities to effectively manage and measure performance and drive patient outcomes. ACOs need to carefully evaluate and select a system that can support workflows and processes across the care management paradigm including:
- Care management – The system must provide the clinician with a holistic view of the patient’s health information including, though not limited to: past medical history, problems, medications, allergies, vitals, personalized goals, etc. The system needs to allow the care team to efficiently document care management activities such as conducting assessments, performing medication reviews, developing care plans, etc.
- Care coordination – The care management system should allow the clinician to track tasks and follow-ups (e.g., consult notes, patient call, etc.). The system should permit the care team to coordinate care amongst themselves, as well, such as assigning a task like a nutrition or social work consult, for example. In addition, the care manager can electronically transmit a summary of care documents to another provider that is involved in the patient’s care.
- Care transitions – The system should alert to the care manager regarding a change in care setting (i.e., ADT feed), and automatically create a task for the care manager to follow-up and support the patient in receiving the right care, at the right time, in the right location.
Organizations that opt to adopt care management technology tools will feel the effects in operational efficiency, team job satisfaction, and quality results. It is practically impossible to manage the vast, complex, and diverse healthcare needs of a population without technology.
The NAACOS survey results express that many organizations that have not started any risk arrangements are very uncertain and feel as though it will be an average of three years before they are ready. This uncertainty is likely spawned from the unknown but just remember while uncertainty is expected, avoidance is not an option – ultimately, it’s the right thing to do to improve quality outcomes and address unsustainable costs. Those making a move today have it a little better than their predecessors with the advancement of population health technology for analytics and care management. With these advanced tools, organizations are better equipped to take on the risk because they have a deeper insight to their population with the ability to identify and act on those patients who will benefit most from care management intervention.
On a final note, as a nurse, I couldn’t be more delighted as I read the section in the NAACOS piece about the value that the care manager role brings to improving healthcare. It’s been years in the waiting as nurses have always held education, prevention, and wellness as core to our practice – and the recognition is heartfelt for all nurses. While we have probably only begun to scratch the surface on improving our industry, it makes me proud to be a part of the transformation.
For more information on the content or author, please contact us.
Becker’s Hospital Review. 2017. How the Pioneer ACOs stacked up on shared savings, quality in 2016. https://www.beckershospitalreview.com/accountable-care-organizations/how-the-pioneer-acos-stacked-up-on-shared-savings-quality-in-2016.html
Becker’s Hospital Review. 2017. How the Next Generation ACOs compared on shared savings in 2016. https://www.beckershospitalreview.com/accountable-care-organizations/how-the-next-generation-acos-compared-on-shared-savings-in-2016.html
Health Affairs Blog. 2017. The 2017 ACO Survey: What Do Current Trends Tell Us About The Future Of Accountable Care? http://healthaffairs.org/blog/2017/10/04/the-2017-aco-survey-what-do-current-trends-tell-us-about-the-future-of-accountable-care/