shared savings power tools to improve mssp …...1 shared savings power tools to improve mssp...

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Shared Savings Power Tools to Improve MSSP Quality Scores

Session 119, March 7, 2018

Jim Whitfill, MD CMO Innovation Care Partners

Faron Thompson, COO Innovation Care Partners

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James Whitfill, MD is President of Lumetis, LLC

Faron Thompson, MBA

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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Agenda

• Who is Innovation Care Partners

• ICP Growth and Success Metrics

• Keys to ICP Success

• MSSP Quality Reporting Evolution

4

Learning Objectives

• Explain some of the challenges that ACOs participating in the

Medicare Shared Savings Program (MSSP) face as related

to reporting, data gathering, and informatics.

• Describe how an open health information exchange (HIE)

platform and a customized ACO-focused application can

seamlessly integrate analytics into reporting and monitoring

workflows to streamline MSSP reporting requirements.

• List three benefits of collecting MSSP reporting data via an

ACO-focused application versus collecting the same data

and outcomes through Excel spreadsheets completed by

more than 60 medical practices with disparate EHR systems.

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What type of organization do you represent?

1.ACO

2.Hospital or Health System

3.Consultant or Service Provider

4.Technology Vendor

6

For the ACO I represent or am most familiar, the ACO has existed for how many years:

1. We are still contemplating becoming an ACO in the future

2. 2018 is our first year

3. 1 year

4. 2-3 years

5. 4+ years

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What is Innovation Care Partners (ICP)?

• Established July, 2012

• Scottsdale, AZ

• Joined MSSP 2014 Track 1

• Now Track 2 for 2018

• CI - Legal mechanism that allows practices to remain independent but work together to provide coordinated quality care

• MSSP – Participant in CMS Medicare Shared Savings Program

Clinical Integration (CI) and Accountable Care Organizations (ACO)

HonorHealth

Innovation

Care Partners

Scottsdale Health

Partners MSSP

John C. Lincoln

ACO MSSP

Commercial and

Medicare Advantage Plans

Wholly owned

Managed by ICP

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Innovation Care Partners Strategic Framework

Physician

Engagement

Care

Coordination

Information

TechnologyCollaboration

Vision: Innovation Care Partners will be the leader in innovative healthcare

delivery with exceptionally high quality, balanced against cost, and will be

the preeminent partner of choice for aligned physicians and payers.

Mission: Innovation Care Partners provides coordinated, high-

value, evidence-based care to improve the health and well-being

of the patients and families we serve.

Values: • Patient-centered

• Physician driven

• Transparent and Fair

• Pluralistic

• Continuously

Improving

ICP Pillars for Success

Clinical & Risk

Analytics

99

ICP Physician Membership +116

95 TINs and 820 Providers in SHP MSSP in 2016

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ICP Member Practice Locations

Legend

Blue = Practice

Purple = Hospital

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ICP is a Pluralistic ACO

• ~ 400 health system employed physicians

• ~ 1200 independent private practice physicians

• ~ 58 health system employed practices

• ~ 403 independent private practices

• > 60 different EMRs

• Most EMRs not yet integrated into ICP’s private health information exchange

108 private practices and 58 employed practices are

in the SHP MSSP

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The ACO that I represent or am most familiar with is:

1.Owned by a Hospital or Health System

2.Physician owned

3.Owned by a Management Company

4.Joint Venture

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Innovation Care Partners is Physician Driven

Over 90% of Committee Members are Physicians

ICP Board of Managers

Operations, Finance,

ContractingQuality Clinical IT Membership

Executive Committee

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Patient Volume Growth > 24%

87,000

covered

lives

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2,900

enrolled

patients

since

program

inception

Care Coordination + 184%

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ICP Shared Savings: Not Just ACO

• UHC Medicare Advantage

– ~6,200 members

• BCBS Alliance Commercial

– ~1,600 members

• Humana Medicare Advantage

– ~4,200 members

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The ACO I represent or am most familiar with:

1.Has earned shared savings

2.Has never earned shared savings

3.Has had mixed results

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2016 SHP MSSP Performance Results

YTD Q4

2016

Final

2016

YTD Q1

2017

YTD Q2

2017

Total Expenditures $180M $182M $211M $218M

Benchmark $200M $201M $243M $252M

Benchmark Minus Total

Expenditures$20M $19M $32M $33M

Savings $9.6M $8.9M $13.2M $13.9M

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Cost vs. Benchmark Trend

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SHP MSSP Historical Performance

# Category 2014 2015 2016Total

Lifetime

1 Number of Beneficiaries 15,530 19,021 19,216

2 Quality Scores 100% 93.76% 96.96%

3 Benchmarks $8,520 $10,329 $10,769

4 Savings $3,741,063 $9,943,847 $18,696,249

5 Savings per Beneficiary $241 $523 $973

6 Earned Shared Savings $1,833,121 $4,568,301 $8,883,074 $15,284,496

7 Earned Shared Savings per Beneficiary $118 $240 $462

8 Increased Shared Savings - Year over Year $2,735,180 $4,314,773

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2016 MSSP Quality Performance

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SHP MSSP Saved CMS Money and

Earned Shared Savings 3rd Year in a Row

Saved $18.7M Earned $8.9M

• The only Arizona-based MSSP that earned revenue for 2016

• The first Arizona MSSP to earn revenue in 2014

• Only Arizona-based MSSP to earn revenue each year since inception (2014)

• Performed in the top 5% of MSSPs nationally in terms of total dollars received

• Had the highest savings rate in the country at 9%

• Scored 97 out of 100 for quality

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100%

93.76% 96.96%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2014* 2015 2016

Quality Trends

*2014 Pay for Reporting Year

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Innovation Care Partners - Keys to Success

1. Engage Physicians

2. Care Coordination and Transitional Care Management

3. Improve access to data for clinicians

4. Improve provider communications and coordination

5. Manage the health of our populationLeads to…

• Improved quality

• Reduced cost

• Improved patient satisfaction

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Engage Physicians

• 3 All Member meetings per year

• Quarterly PCP meetings

• Monthly newsletter

• Physicians on board and 5 committees

• Independent sister physician organization

• Support physicians with useful and easy-to-use technologies

• Pay care management payments to PCPs quarterly tied to engagement in quality programs

• Pay gain share

• Measure engagement using “citizenship points” and hold as threshold for membership and gain share

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Care Coordination &

Transitional Care Management

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Improve Access to Data for Clinicians

• Robust private health information exchange

• Easy to use

• Longitudinal patient record combining patient data from multiple disparate sources

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Improve Provider Communications

& Coordination

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Manage the Health of Our Population

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SHP’s MSSP Quality Reporting Journey

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Technology and Process Evolution

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For the ACO I am most familiar with, annual quality reporting is:1. A piece of cake

2. Complex but we have it under control

3. Challenging and interested in better approaches

4. 2018 is the first year for quality reporting

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For the ACO I am most familiar with, we have ___ EMRs:1. 1

2. 2-3

3. 3-10

4. 10+

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Year 1 – What Did We Get Ourselves Into?

People Process Technology

Office Managers Quality Reporting Kick-off Meeting Excel

Webinar training sessions Back end data processes

to import from excel

Securely e-mail spreadsheets back

and forth

Secure e-mail

ICP ACO Staff Review spreadsheets for

completion and chase practices to

complete

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2014 Quality Reporting Tool

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2014 Performance Year Results

Quality Score: 100% reported (pay for reporting year)

Shared Savings Earned: $1.8M

Shared Savings Left on Table: $0

However, 65% equivalent score

Shared Savings Left on Table at 65%: $640k

2014 Week 1 Week 2 Week 3 Week 4 Week 5

Percent Complete by Week

1% 11% 27% 67% 80%

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Performance Year 1 – Lessons Learned

• Poor attendance at the kickoff and webinars

• Quality reporting tool was not user-friendly

• Not enough education on quality measures

• ICP staff spent most time chasing practices to complete assignments

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Year 2 – Build a Mouse Trap


Office staff that will

perform the quality

reporting

Quality Reporting Kick-off

Meeting

Web-based MSSP quality

reporting software

Incentives to participate

early

Live in-person mandatory

training sessions

Pre populate quality

metrics from Health

Information Exchange first

ICP ACO Staff Analyze the quality scores

and focus on seeking data

from additional encounters

Access Database for

analysis

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Quality Exchange

• ACO quality

reporting tool

• Captures data

where ICP has it

already

• Easy entry for

office staff

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Quality Exchange is Easy to Use

Quality Exchange

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How Does It Work?

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How Does It Work?

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Quality Data Follow-Up Analysis

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2015 Quality Score 91% Projected 2016 Quality Score 93%

Total Passed Rate 91% Total Passed Rate 93%

Total Failed Rate 9% Total Failed Rate 7%

Grand Total 58 Grand Total 92

8 Pay for Performance Measures in 2015Passed Eligible Patients

Sample Practice

Name SHP Goal

Fal ls Risk Assessment (N=8) 8 8 100.00% 52.67% 73.38%

Ischemic Vascular Disease (Aspirin) (N=7) 7 7 100.00% 90.97% 90.00%

Influenza Immunization (N=5) 5 5 100.00% 61.75% 90.00%

Pneumococcal Vaccination (N=8) 8 8 100.00% 51.14% 90.00%

Body Mass Index Screening & Fol low Up (N=8) 8 8 100.00% 84.13% 90.00%

Tobacco Use Assessment & Cessation Intervention (N=8) 8 8 100.00% 94.70% 90.00%

Hypertens ion Control (<140/90) (N=11) 8 11 72.73% 71.09% 79.65%

Depress ion Screening (N=3) 1 3 33.33% 54.88% 51.81%R ed = D id no t m eet go al; Green = Go al m et

5 Additional Pay for Performance Measures in 2016Passed Eligible Patients

Sample Practice

Name SHP Goal

Coronary Artery Disease - ACE Inhibi tor or ARB Therapy (N=7) 7 7 100.00% 81.38% 91.67%

Heart Fa i lure - Beta Blocker Therapy for LVSD (N=1) 1 1 100.00% 85.92% 90.00%

Mammography Screening (N=8) 8 8 100.00% 58.39% 90.00%

Colorecta l Cancer Screening (N=12) 11 12 91.67% 47.78% 90.00%

High Blood Pressure Screening & Fol low Up (N=6) 6 6 100.00% 77.32% 90.00%R ed = D id no t m eet go al; Green = Go al m et

3 Pay for Reporting MeasuresPassed Eligible Patients

Sample Practice

Name SHP Goal

Mental Health - Depress ion Remiss ion n/a n/a n/a n/a n/a

Diabetes - HbA1c poor control (N=7) 3 7 42.86% 21.60% n/a

Diabetes - Retina l Eye Exam (N=7) 5 7 71.43% 37.11% n/a

Diabetes - Compos ite (A1C+Retina l Exam) (N=7) 4 7 57.14% 32.93% n/a

Medication Documentation n/a n/a n/a n/a n/a

2015 ACO Annual Quality Reporting Performance

Sample Practice Name

93%

7%

TotalPassed Rate

Total FailedRate

Projected Score for 2016 Pay-for-Performance Measures

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Falls RiskAssessment

(N=8)

IschemicVascular Disease(Aspirin) (N=7)

InfluenzaImmunization

(N=5)

PneumococcalVaccination

(N=8)

Body Mass IndexScreening &

Follow Up (N=8)

Tobacco UseAssessment &

CessationIntervention

(N=8)

HypertensionControl

(<140/90)(N=11)

DepressionScreening (N=3)

8 Pay for Performance Measures in 2015

Sample Practice Name SHP Goal

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Coronary Artery Disease -ACE Inhibitor or ARB

Therapy (N=7)

Heart Failure - BetaBlocker Therapy for LVSD

(N=1)

Mammography Screening(N=8)

Colorectal CancerScreening (N=12)

High Blood PressureScreening & Follow Up

(N=6)

5 Additional Pay for Performance Measures in 2016

Sample Practice Name SHP Goal

91%

9%

Total PassedRate

Total FailedRate

Overall 2015 Pay-for-Performance Measures Only

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Quality score: 94%


Shared Savings Left on Table: $304k

Shared Savings Left on Table at 65%: $1.4M



46% 60% 76% 84% 88%

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Performance Year 2 - 2015

Lessons Learned

• Rave reviews from users for new software

• Incentives promoted friendly competition among practices

• ICP ACO staff focus on quality metric improvement was much better use of time

• Minor software tool bugs & issues

• Not enough education on quality measures

• Inconsistent patient attribution

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Year 3 – Build a Better Mouse Trap


Office staff that will

perform the quality

reporting

Quality Reporting Kick-off

Meeting

Enhanced web-based

MSSP quality reporting

software

Incentives to

participate early

Live in-person mandatory

training sessions with more

training on the quality metrics

themselves

Pre populate quality

metrics from Health

Information Exchange first

ICP ACO Staff Analyze the quality scores and

focus on seeking data from

additional encounters

Improved Access database

for analysis

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Quality score: 97%


Shared Savings Left on Table: $310k

Shared Savings Left on Table at 65%: $1.4M

2016Week

1Week 2 Week 3 Week 4 Week 5


41% 64% 81% 85% 95%

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Performance Year 3 - 2016

Lessons Learned

• Improved software was easier to use

• Require data validation during the reporting period

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MSSP Quality Reporting

Process Acceleration



1% 11% 27% 67% 80%



46% 60% 76% 84% 88%



41% 64% 81% 85% 95%

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Alignment to HIMSS Value Framework

• Commercially available tools now exist to improve

the quality reporting experience for practices and

ACOs. Therefore, all ACOs don’t have to repeat the

learning curve.

• Physician/practice engagement is critical

• Quality measure capture using secure technologies

• It is very possible to achieve high MSSP quality

reporting scores without being vertically integrated

and on a single EMR

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Questions

[email protected]

@jwhitfill

[email protected]

www.ICPHealth.com

Please complete online session evaluation

mailto:[email protected]

mailto:[email protected]

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