Winning the ACO game in 5 plays Even when officials change the rules of the game

Presenters

Kathy Maddock BSN, MSA, FACMPE

Executive Team Southern Maryland Integrated Care

ACO

Niki Buchanan

PHM Leader

Philips Wellcentive

Track 1 changes: More risk, little time to prepare

CMS is shifting

80% of Track 1 MSSP ACOs to more downside risk

Many of the Track 1 ACOs ending

2018

(finished 6 yrs): 6 months to take on risk or exit

Cycles: From 3 years to 5 years

5 to 6 mini tracks starting mid

2019

• Are you playing offense or defense?

• Need to play both well, with special teams

• Defense: Keep risk steady for existing beneficiaries to avoid losing ground

• Offense: Capture HCC codes accurately for all new beneficiaries to increase your risk profile

What game are you playing?

#1: Know your players and network strategy Who should be on your team?

Initially, quantity over quality

Timing is critical – provider recruitment period is only once a year

History of shared savings will help you recruit

After getting data, need to cut poor-performing practices from the team

Be intentional – don’t worry about hurt feelings or you bring down your best players

Grow through continual marketing to practices and expect some attrition

#2: Have the right technology

Need tools that enables you to: • Aggregate data from disparate EHRs • Share internally to increase transparency • Analyze performance and identify

opportunities for improvement • Report metrics quarterly to align teams and

check for disparities in attribution • Be prepared to share data back to the EHR to

enable continuity of patient records

Functionality you need to succeed: • Connectivity to HIEs • Elements such as ADT alerts for following

the patient through the network • Predictive analytics tools and stratification

of highest utilizers of care • Providers must access and analyze their

own data • GPRO reporting tools

#2, Cont.: The right technology

Creating a sharable longitudinal record

• Within a single technology platform

• Track vital signs and lab result trends

• Single source of documentation leads to integrated care plans

#3: Drill down deeper

1. 5-yard gain with provider education – need to translate ICD-10 codes into 79 HCCs each year

• Diabetes example – thousands of ICD-10 codes, but only 3 HCC codes

• Physicians may document abnormal signs and symptoms but need to focus on CMS requirements

• Create process tools in practice or for physician

• Use other visits- AWV to capture HCCs

#4: Risk coding strategy

2. 4-yard gain: Data analytics • Physicians need prior year HCCs at the

point of care • Getting the data to the practices is key

#4, Cont.: Risk coding strategy

3. Annual wellness visit capture

• A great time to capture HCC codes

• Inside vs. outside approaches

• Spend time working with each practice to maximize capture of these visits

#4, Cont.: Risk coding strategy

• Include all post-discharge care for your attributed beneficiaries, not just SNFs

• Identify the top hospitals discharging your patients

• Work with hospitalists to break the readmission cycle

• Your game plan should coordinate post-acute interventions with other players – e.g., the hospital care manager

#5: A true post-acute strategy

Activate patients with chronic conditions to better health at home:

• Reduce healthcare utilization and cut costs

• Leverage existing staff more effectively

• Remote patient monitoring for patients across the acuity spectrum

• Medication adherence solutions to help patients take the right medications at the right time

#5, Cont.: A true post-acute strategy

• You have to be able to take on downside risk

• Attributed patients — size matters in managing risk

• Make sure you capture HCC codes of new beneficiaries

• ACOs with smaller pockets will struggle to repay penalties

• Providers need direct access to timely claims data

• Good analytics at the point of care are key

• MIPS is likely to make recruitment harder

The end game: Putting it all together

Questions