Posted in Accountable Care, ACO, Affordable Care Act, Triple Aim

ACOs Fudging the Numbers?

by Gregg A. Masters, MPH

I came across this piece on the Healthcare Blog penned by Kip Sullivan, Esq, critiquing this article posted in Health Affairs last May ‘Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO‘. Sullivan raises valid points as the the legitimacy of claiming or inferring statistically insignificant results as a meaningful contribution of the subject ACO (a Partners Health sponsored venture) to ‘bending the cost curve’.

Sullivan un-bundles his argument effectively and raises issues for the industry writ large – including participating ACOs, their sponsors, the regulatory crew at both CMS and CMMI – and even the health policy press covering the sector.

I post the first few paragraphs of the piece below, for full reference the entire article on the Healthcare Blog is accessible via On the Ethics of Accountable Care Research‘.

  • Is it ethical for health policy researchers to claim that a Medicare ACO reduced “spending” by 2 percent if the reduction was not statistically significant?
  • Is it ethical for them to do so if they made no effort to measure the cost to the ACO of generating the alleged 2 percent savings nor the cost to Medicare of giving half the savings to the ACO?
  • Does it matter that the researchers work for the flagship hospital within the ACO that was the subject of their study?
  • Does it matter that the ACO and the flagship hospital are part of a huge hospital-clinic chain that claims its numerous acquisitions over the last quarter-century constitute not mere empire-building but rather “clinical integration” that will lower costs, and the paper lends credence to that argument? 
  • Is it ethical for editors to publish such a paper? Is it ethical to do so with a title on the cover that shouts, “How one ACO bent the cost curve”?

These questions were raised by the publication of a paper  by John Hsu et al. about the Pioneer ACO run by Partners HealthCare System, a large Boston hospital-clinic chain, in the May 2017 edition of Health Affairs. Of the eight authors of the paper, all but two teach at Harvard Medical School and all but two are employed by Massachusetts General Hospital (MGH), Partners’ flagship hospital and Harvard’s largest teaching hospital. [1]

Partners has been on a buying and ….

Comment

As someone who’s been in this dance since the mid 70s (PSROs, HSAs, HMOs, IPAs, PPOs, EPOs & all derivative plays) launched into Medicare risk via TEFRA (the Tax Equity and Fiscal Accountability Act) which introduced us to ‘Medicare Choice’ the for-runner of Medicare Advantage, I can say Sullivan’s critique of fully ‘burdening‘ ALL transformational efforts is rarely – if ever – factored into the volume to value pivot ‘investment calculus‘ of the effects of the intervention (in this case a Pioneer ACO) on the national spend.

It should be noted, the entire managed care industry can be assessed a gigantic collective FAIL for that matter as well. Since managed care penetrated ‘mainstream medicine‘ principally via extension of the HMO model typically on an IPA (independent practice association) chassis (vs. group or staff models) with the exception of a brief period in the 90s premiums continue their relentless upward march; while most payors continue to write commercial business only via an enterprise and industry wide cost shifting (risk transfer) charade. The tacit admission that there is no there there in the prevailing health insurance industry zeitgeist. They’ve proven they can NOT manage clinical risk, period.

So Kip, you might want to go a little lighter on those on the front lines trying to tame the ‘rapacious appetite’ of our ‘healthcare borg‘!

 

 

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Posted in Accountable Care, ACO, Affordable Care Act, Medicaid ACO

Tufts Health Plan Forms MassHealth Accountable Care Organization Partnership with Four Provider Organizations

Press Release | Watertown, MA | August 18, 2017 

The Massachusetts Executive Office of Health and Human Services (EOHHS) recently announced that Tufts Health Plan has signed contracts to form Medicaid (MassHealth) Accountable Care Organization (ACO) partnerships with four provider organizations:  Atrius HealthBeth Israel Deaconess Care OrganizationCambridge Health Alliance, and Boston Children’s Accountable Care Organization.

The new ACOs feature a value‐based payment structure for providers who had largely been paid fee for service for MassHealth members in the past.  For members, this means the opportunity to receive medical, behavioral, dental and long-term support services in an integrated model of care.  This will improve quality of care, the member experience, and potentially help stabilize Medicaid costs in Massachusetts.

“We support the Commonwealth’s goal of providing integrated health care to MassHealth members that is more efficient and improves their overall health,” said Tom Croswell, president and CEO of Tufts Health Plan.  “We have partnered with four highly-regarded provider groups, all of whom share our vision of what collaboration and highly coordinated care can look like.”

Continued Croswell:  “Tufts Health Plan has an excellent reputation for our collaborative approaches with providers.  We’ve been working with value-based contracts for more than 20+ years, starting in our Medicare Advantage plans.  We know first-hand that working closely with providers on coordinating care results in healthier members.  We’re excited to broaden our success and bring this approach to our Medicaid members.”

MassHealth ACO transformation is a major component in the state’s five-year innovative 1115 Medicaid waiver from the federal government, which allows Massachusetts to restructure the current health care delivery system for 1.9 million MassHealth members.

Tufts Health Plan’s ACO partners are:

  • Atrius Health, which provides high quality, patient-centered and coordinated care to more than 740,000 adult and pediatric patients in eastern and central Massachusetts.
  • Beth Israel Deaconess Care Organization, a value-based physician and hospital network that partners with providers to improve quality of care while effectively managing medical expenses.
  • Boston Children’s Accountable Care Organization is an ACO comprising Boston Children’s Hospital and its affiliated primary and specialty care physicians. Boston Children’s Hospital is the No. 1 ranked Children’s Hospital in the nationand is a 415-bed comprehensive center for pediatric and adolescent health care.
  • Cambridge Health Alliance, an academic community health system committed to providing high quality care in Cambridge, Somerville and Boston’s metro-north communities. CHA has expertise in primary care, specialty care and mental health/substance use services, as well as caring for diverse and complex populations.

 

Editor’s Note: We are in the process in scheduling a Tufts Health Plan executive on an episode of This Week in Accountable Care with Andre Berger, MD and Alex Foxman, CEO and President/CMO of National ACO. Once confirmed we’ll post the details here with a profile of Tufts Health.

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Posted in Accountable Care, ACO, LTPAC

Florida Association of ACOs Partners with Caredove

Sponsored Post:

22 Aug 2017 7:00 AM | Jacksonville, FL

Partnership Broadens Florida Based Organization

The Florida Association of ACOs (FLAACOs), the premier professional organization for Accountable Care Organizations (ACOs) and value based healthcare leaders throughout Florida, announced today a strategic partnership with Caredove, Inc. to provide its Statewide ACO membership with access to Caredove’s advanced, online e-referral platform which focuses on making it easy to transition patient care into home care and community services.  Under the agreement, Caredove will work with FLAACOs and its ACO members to establish and build out trusted networks between its ACO members and the organizations and agencies providing home care and community support services in the communities they serve.

Nicole Bradberry, CEO of FLAACOs, states:

“Our partnership with Caredove shows our continued commitment to bring additional value to our members and to take a leadership role in helping to address those aspects of care needs to help our member’s patients stay healthier in their homes and communities and to avoid costly readmission into the Acute care system”.

 It is anticipated that over 1000 home care and community agencies will be implemented on the platform, serving some 40+ ACOs across the state.  Caredove’s CEO, Jeff Doleweerd, said

“We spent thousands of hours examining how patients access service to different home care and community services. We saw the same problems over and over. Clinicians couldn’t locate helpful services, patients didn’t know what would happen next, intake staff were overwhelmed while triaging referrals, voicemails would pile up, and patients wouldn’t get connected with the care they needed. We created Caredove to solve these problems”. 

The development of the initial e-Referral networks in Florida under this agreement will pave the way for additional parties to join the platform.  We’re happy to be working with FLAACOs to bring Caredove to benefit the patients of their ACO members.”

Richard Lucibella, CEO of Accountable Care Options (Boynton Beach Florida) and FLAACOs Board member, is an early adopter on the Caredove platform. 

“As we’ve extended our Chronic Care Management efforts, we’ve gained a better understanding of the extent to which behavioral health and community social services can impact out patients’ health status. We’ve all known this to be an issue, particularly in the Medicare population.  Our CCM teams at Accountable Care Options continue our leadership position here on behalf of our patients, and are excited about the very real promise of the Caredove platform to support and potentially multiply our current efforts.”

“Overall, we’re seeing great interest and excitement about the platform in Florida and elsewhere”, says Jim Atkinson (Chief Growth Officer at Caredove), “and, we are working to expand the network through Community & Public Health groups as well as to bring Payers and Health Systems into the trusted exchange.”

ABOUT FLAACOs                                                                                                 

FLAACOs, also known as the Florida Association of Accountable Care Organization, mission is to provide members a vehicle to collaborate, ensuring that each healthcare organization grows and thrives. The Florida-based association aligns goals to help member ACOs shift physician incentives and improve health-care outcomes across the state. FLAACOs provides a voice for the accountable care marketplace and its participating providers, payers, and individual physicians. The goal of FLAACOs is to provide advocacy and support to all Florida accountable care organizations so that together they can become the health-care models of the future. To learn more click here.

ABOUT CAREDOVE                                 

Caredove is a healthcare solutions company providing its online platform to make it easy for patients to gain access to home care and community services.  Providers and care coordinators, as well as patients and family caregivers, can Search for geo-available home care and community services, Book appointments and e-referrals directly into those services, and Connect through secure data communication and organization-specific referral and intake workflows.  Caredove is a true healthcare platform that builds trusted webs between Referrers (Providers/Care Coordinators), Service Providers and their mutual patients.   Caredove currently covers over 80 categories of Home Care and Community Services.  On the platform referrals are always free and it’s easy to invite referrers and service providers to the network so there is no impediment to its growth in serving each local community. For more information, click here.

 

Posted in Accountable Care

The ‘Value Pivot’: The CAPG Story

by Gregg A. Masters, MPH

While HMOs have been around since President Richard Nixon – yes a Republican who embraced the vision of ‘universal coverage‘ for Americans via the HMO Act of 1973 – healthcare stakeholders in the volume fueled fee-for-services (FFS) ecosystem have been mostly change resistant with some exceptions.

Nixon’s sanguine call for a National Health Strategy in 1971 will put today’s health policy and serial frustrations around building common ground on health reform in an important historical context and frankly serve as a wakeup call to all the late comers in this conversation who are just discovering that ‘health care is complex‘.

Nixon noted:

The toughest question we face then [post passage of Medicare and Medicaid] is not how much we should spend but how we should spend it. It must be our goal not merely to finance a more expensive medical system but to organize a more efficient one. – President Richard M. Nixon 1971

He further opines a theme we’re rather familiar with today whether it by the increasing popularity of direct or retainer based medical practice or the resurgence of the HMO model particularly the growth of Medicare Advantage plans:

Emphasizing Health Maintenance. In most cases our present medical system operates episodically–people come to it in moments of distress–when they require its most expensive services. Yet both the system, and those it serves would be better off if less expensive services could be delivered on a more regular basis.

If more of our resources were invested in preventing sickness and accidents, fewer would have to be spent on costly cures. If we gave more attention to treating illness in its early stages, then we would be less troubled by acute disease. In short, we should build a true “health” system-and not a “sickness” system alone. We should work to maintain health and not merely to restore it.

ACA Repeal, Replace or Fix?

Some 36 years later we can still relate to Nixon’s goals for a National Health Strategy and are far from it’s fulfillment in terms of migrating from a ‘sick-care’ to a preventive or wellness based system. All of the talk about population based payments or value based healthcare notwithstanding, our system of financing and delivery remains a fee-for-services, do more to earn more web of financial incentives. This is changing though very slowly.

As has been noted elsewhere:

‘The future is already here – it’s just not evenly distributed’. – William Gibson, The Economist December 4, 2003

Given the variable and regional distribution of ‘innovation‘ in business or service delivery models supporting alternatives to traditional fee-for-services medicine, we in the healthcare sector can certainly attest to Gibson’s observation. While contextual to the tech sector it is wholly applicable to transformation efforts in healthcare.

It’s noteworthy that when Nixon signed the HMO Act into law in 1973 it was to ‘to help demonstrate the feasibility of the HMO concept over the next 5 years‘, see: Statement on Signing the Health Maintenance Organization Act of 1973.

Yet the HMO model had been incubating for a while, i.e., Kaiser Permanente dates back to 1947, as does the Ross-Loos Medical Clinic (1929) and Group Health Association of D.C. (1937). So indeed, innovation uptake in the healthcare sector does have its own unique ‘footprint‘ and experience.

Before pivoting to today’s theme, I want to underscore the glacial pace with which the healthcare delivery and financing sector embraces change. Consider this classic observation to frame both the optimism and nature of the challenge via Charles H. Mayo, MD of Mayo Clinic fame.

Many are called to the healthcare services industry with a range of motivations, some from a sense of mission to serve others, while another cohort focuses on the upside of financial gain resulting from cures to it’s many inefficiencies and inequities.

I suspect some of Dr. Mayo’s optimism envisioned what was to come via the above pioneers in the prepaid world of HMOs that Nixon codified into law in 1973.

Meet Don Crane CEO CAPG

True to form with the uneven distribution of innovation, it’s fact that certain geographic regions have witnessed more or less ‘innovating‘ away from the industry standard FFS platform. California has been in the forefront of provider risk assumption since the mid- 1980s. HMOs in California prior to the expansion into ‘mainstream medicine‘ via the independent practice association (IPA) movement, where of the staff or group model variety. Their market share was relatively low and they remained a ‘niche play‘ of typically labeled ‘second rate‘ medicine by their mainstream ‘bretheren’. However, the handwriting was on the wall as to the directional vectors for both financing and the delivery of care.

Born as the California Association of Physician Groups, CAPG sensing the need to share and migrate both it’s philosophy and core competencies in risk assumption and operational excellence began a national expansion. From a California focused association of risk savvy medical groups, CAPG is now advocating and supporting scheduled and scaled risk assumption by member groups nationwide. It’s mission statement notes:

CAPG is the leading association in the country representing physician organizations practicing capitated, coordinated care. Our membership currently comprises close to 300 multi-specialty medical groups and independent practice associations (IPAs) across 42 states, the District of Columbia, and Puerto Rico.

Tuesday, July 25th at 5PM Pacific/8PM Eastern on This Week in Accountable Care, NACO co-founders Andre Berger, MD and Alex Foxman, MD will engage Don in a broad conversation on value based healthcare economy including alternative payment models (APMs), ACOs, the promise of it’s Next Generation Models and the performance of Medicare Advantage plans.

Join us!

 

 

Posted in Affordable Care Act, BCRA 2017

CBO Weighs in on Trumpcare 3.0

by Gregg A. Masters, MPH

The non-partisan Congressional Office weighed in today on the impact of the Better Care Reconciliation of of 2017 as amended and rebranded as the ‘Obamacare Repeal Reconciliation Act’.

Their summary notes the coverage impact as follows:

  • The number of people who are uninsured would increase by 17 million in 2018, compared with the number under current law. That number would increase to 27 million in 2020, after the elimination of the ACA’s expansion of eligibility for Medicaid and the elimination of subsidies for insurance purchased through the marketplaces established by the ACA, and then to 32 million in 2026.
  • Average premiums in the non-group market (for individual policies purchased through the marketplaces or directly from insurers) would increase by roughly 25 percent—relative to projections under current law—in 2018. The increase would reach about 50 percent in 2020, and premiums would about double by 2026.

On the fiscal impact the graphic lays it out below:  For a complete CBO report, click here

Posted in Affordable Care Act, health insurance reform, health reform

Senate GOP Health Reform Fail: Many Knew This Day Was Coming

by Gregg A. Masters, MPH

Unlike many in the conversation on social media including the likes of Twitter, Facebook, LinkedIn and blogs such as ACO Watch, I have been active in the health reform exchange of ideas since registering my twitter handle @2healthguru in August of 2008. My participation has been of the ‘sweat equity’ variety vs. those who are compensated for their content, curation or advocacy.

Many of us in the healthcare space (both clinical and administrative) are addicted to the industry and find it difficult if not impossible to exit whether physically or emotionally. Some commit out of a sense of missiongiving back or being of service, while others for the economic upside this vast ecosystem (which I have labeled the healthcare borg resisting any attempt to materially restrain its appetite) affords to exploit low hanging fruit from a fragmented, inefficient and unwieldy financing and delivery system. Many have personally enriched themselves via the frequent churn of asset ownership (hospitals, nursing homes, imaging centers, ambulatory surgery centers, etc.) or via niche solutions with little to no sustainable value followed by quick exits and generous investor returns.

This timing of my entry into social media was co-incident with the deliberative process that ultimately rendered unto the American public what was merged as the Affordable Care Act (ACA),

In the early days of twitter those of us active in the community spoke of the ‘addictive’ nature of twitter engagement, some even referred to this virtual community as ‘the matrix’. Bonds were formed, some of which remain intact to this day.

The ‘Fictional’ Obamacare ‘Disaster’

This morning Donald J, Trump aka the POTUS weighed in on the failed efforts of Senate GOP leadership to advance the Better Care Reconciliation Act of 2017 as amended by Senator Ted Cruz to the Senate floor. He said:

By the way Obamacare isn’t failing, it’s failed

That this man continues to minimally misrepresent and worse intentionally lie to the American public is beyond the capacity for many to comprehend. From the American Academy of Actuaries to the Non-partisan Congressional Budget Office and multiple authorities in the underwriting to delivery space including risk bearing provider organizations and integrated delivery systems the narrative is quite to the contrary.

And where there is evidence of market instability or ‘failure‘ there is explanation including serial GOP initiatives to undermine the Affordable Care Act specifically with respect to ‘qualified health plans‘ (QHPs) listed on State run or Federally Facilitated Marketplaces (FFM) aka ‘Exchanges.’

The ‘death spiral‘ or ‘disaster‘ narrative is principally vested in the following argument:

  • Major health plans and regional players who initially developed individual market product(s), i.e., benefit plans, and associated provider networks including premiums) for these exchanges are withdrawing participation from select markets.
  • Premiums for some QHPs have increased by 100% or more on select exchanges; and
  • In some states and select counties there are no participating health plans with QHPs offered

On the face of this narrative, yes it makes sense. This market instability is unacceptable. No one can celebrate a law who’s principal intent is to expand coverage can applaud the absence of health plan participation at the state or county level.

But let’s peel back the curtain and look at the reasons for this ‘instability‘ claim. From day one of the Obama Administration, the GOP agenda was to make him a ‘one term President‘.

On the ACA given it’s passage was a straight line party vote with no support from GOP even though the health reform consideration process was an open and lengthy affair, Senator McConnell et al’s agenda was to remain the ‘party of no‘ and criticize the very model of health reform they had not long ago proffered as a public/private solution,  See: ‘GOP ACA Myths‘ where I’ve posted links to credible voices and JD Kleinke’s classic: ‘Why There Is No Obamacare Replacement — In One Picture‘. 

The bottomline is any ‘fails’ or under performance of the ACA whether enrollment projections, premium sticker shock, exchange exits or regulatory burdens have been engineered by a relentless series of sabotage efforts from defunding risk corridors, to current (see: This Blame Game Driving Up Health Insurance Costs) threats to not fund the subsidies that make QHP listed plans ‘affordable‘. And let’s not forget the big SCOTUS decision on Medicaid expansion which gave Red State Governors the ‘option’ whether to expand coverage for their citizens.

Karma?

So the ‘who knew healthcare was so complex’ remark offered by POTUS earlier this year was pure BS. I buy his ignorance of health policy and the complexity inherent in a cottage industry with a $3+ trillion spend, but what about those GOP ‘health wonks’ engaged in this process – from the ‘Senate Quackers’ (my term), i.e., Tom Coburn and John Barrasso – both politicians playing the doc card during ACA markup in 2009, or even worse one half of the GOP ‘young guns’ now Speaker Ryan who’s a budget [and by declaration health] wonk. What’s their excuse for this ‘surprisingly epic fail’?

This is a HUGE squander of the public trust!  And contrary to POTUS assertions, the GOP now has complete ownership of the chaos they’ve stoked from the beginning to this gross mis-management of the legislative process. It’s laughable that GOP are trying to pin this one on the Democratic party.

My god, wake up GOP. You ‘own’ healthcare. Fix the ACA.

Posted in Accountable Care, ACO

A Day in the Life of an ACO Chief Executive

By Gregg A. Masters, MPH

Transforming a $3.2+ trillion dollar economy where approximately 1 in 5 dollars of GDP finds its way into the healthcare financing and delivery ecosystem is no small challenge. Decades of variably branded health policy initiatives from HMOs and PPOs to their arguably derivative reincarnated ‘brethren’ ACOs all presented with the promise of taming what remains a rather rapacious appetite for ‘more‘ in a complex do more to earn more web of financial incentives.

The most recent addition to this effort was delivered via the Affordable Care Act courtesy of President Obama in March of 2010. Accountable Care Organizations (ACO’s) are defined as follows:

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  –  Centers for Medicare and Medicaid

Meet Dr. Andre Berger

Andre Berger, MD is a busy man committed to move the needle towards the seemingly conflicting goals of the ‘tripe aim’ – better experience of care, with improved outcomes at lower per capita costs.

This multi-board certified physician has a lot on his plate – a busy cosmetic surgery and anti-aging medical practice as well as the chief executive officer of a primary care physician led and governed next generation accountable care organization (ACO) with a successful five year operating history.

I first learned of  Dr. Berger as a result of my interest following and reporting on Accountable Care Organizations (ACOs) for ACO Watch. Dr. Berger was listed as the CEO of National ACO admitted to the first class of participating ACOs in the Medicare Shared Savings Program (MSSP) as an advanced payment model. Then I noticed the office for National ACO was headquartered in Beverly Hills, California on the very street I called ‘home’ while serving as Director of Managed Care for American Medical International (now operating as Tenet Healthcare) California Region –  I thought to myself what a coincidence! I need to learn more about this enterprising physician and wondered why a surgeon specializing in a direct pay (non 3rd party reimbursed) specialty for often ‘non-covered’ services from a typical group or individual health benefit point of view, be leading such an effort?

This co-mingling of seemingly divergent interests convinced me there is a deeper story to uncover possibly with an important message for physicians, hospitals, and patients given the current instability of our volume driven healthcare delivery and financing model.

Fast forward some four years + later, and I’ve been invited to advise National ACO on their social media presence and to develop a portfolio of digital assets for a growing thought leadership library.

On recent trip from South Lake Tahoe to cover BIO 2017 the global annual go-to gathering of the best and brightest minds in the biotech sector in San Diego, I was invited in to ‘shadow’ Dr. Berger and get a feel for a typical day in his life at the helm of National ACO.

Tuesday 8:30 AM

While Dr. Berger is CEO of National ACO (NACO) a growing enterprise with lean staffing he maintains his clinical practice so balancing workflow is a challenge addressed by having dedicated NACO days, and in office or surgery patient days. Today was an NACO day.

Dr. Berger arrives at the office equipped with briefcase including his accessorized iPhone, MacAir, iPad. AppleWatch, associated peripherals and a series of file folders. What follows is a series back-to-back phone calls, tech-enabled virtual staff meetings and seemingly non-stop text messaging.

The first call is with the Medical Director of NACO’s PET (provider engagement team) and the subject is physician performance (both quality and financial) reviews.

Next up is executive staff meeting with a long list of action items finalizing a progress report due to CMS.

Key themes include overall and regional performance of  on annual wellness visits (AWV) and chronic care management (CCM) programs.

Given growth in NACO there’s considerable discussion on staffing needs, particularly acute is recruiting a Director of Care Management given a tight market and low supply of candidates, NACO may need to retain search firm. Finding qualified case managers and care management staffs sound equally challenging.

The ‘mobile physician’ waiver (allowing physician access to patient’s homes to provide transitions of care consults) is delegated to the chief medical officer, NACO plans to deploy in Q3. Will help with CM staffing and population management.

Provider Network Managers to inventory ‘at risk’ patients to put on care managers’ priority screening. Is vendor a reliable source? May need to vet further for accuracy and then prioritize.

Other agenda items included: contracting with nursing homes, hospice providers, reviewing stop loss policy, discussion of ESRD patient mix, and possibility of contracting with key nephrologist or nephrology group(s).

All with intent to ID ‘preferred providers’ and ultimately tag for population based payments.

9:30 AM GOTO Meeting Conference Call (to review performance results)

Reviewing IT vendor dashboard detailing physician performance by ACO, region, etc. Considerable discussion on the need to manually design custom reports and the duty of that burden falling on the physician or whomever is pulling the data have to input the requested parameters.

Further discussion topics include: evidencing completion events for quality metrics reporting, the status of hospital real time ‘ping system‘ alerting ACO physicians of admits, discharges or transfers. It was affirmed that efficacy of the notification program requires two pings: one to admitting physician, the second to NACO medical director.

Considerable discussion on vendor performance and opportunities for workflow improvement.

HR issues (mostly need for additional staff).

Dilution agreement (issues associated with NACO capital raise via PPM to participating physicians, medical groups or IPAs.

10:10 Management Meeting – Agenda

Routine conversation on travel policy and company preference to avoid ‘non refundable’ airline ticket purchases. Recommended leveraging tools available via concierge support services as often as practical.

Balance of meeting agenda deferred to NACO operations manager. On tap is IRR review of ’Project Plan Requirements’.

Define compliance reporting to NGACO Governing Body members. What does this include? In the minutes. All needs to line up with contracting obligations.

Definition of ‘beneficiary representative’ who is this? Definition of ‘Certified Participants’? Quest was submitted by NACO as ‘preferred provider’.

Same (COI) issue for ‘consumer advocate’.

Key issue is defining ‘joint venture’ (JV)? For purposes of disclosure requirements. Are lab vendor relationships a JV? What about PBMs?

Training and Education program need be developed. Need to source CMS requirements NGACOs.

Need project format with due dates and compliance checks.

Letter re: advantages of joining NACO. Details calculations and benefits of affiliation.

Need fine tune the ‘marketing materials’ for physician recruitment and any special considerations for appeal via IPAs.

Physician outreach need stay away from ‘guarantees’, but stipulate shared savings participation on an ongoing performance basis.

Next Generation ACO Deadlines and Calendar: Webinar schedule, voluntary alignment dates, provider risk stratification meeting, the need for executive breakout session to review tier assignment, engagement level and appropriate notice and cure periods. Deadline is 9/29 for removal from NACO panels. Report period 2017 or rolling 12 months.

Recent submission to CMS certified. Break out by physicians, TINs and preferred providers.

Population Based Payment: what’s plan, deadline and status?

PBP Agreements are just now being sent out to target physicians.

Follow-up planned one week post mailing.

Senior staff query: how are we engaging our medical directors to facilitate recruitment and participation PBP program? May need to develop video on PBP program directed to target physicians with outreach via NACO medical directors.

Chronic Care Management program update included number of care plans completed, outbound call volumes, number of patients in program, sorted by minutes to meet marks.

Care Manager recruitment status report.

Revenue pro-forma review, including ‘consent’ status and whether ‘on plan’ or not.

Group recruitment update: Signs two agreements to perfect NACO/Group relationships: TIN affiliation agreement, and group participation agreements.

Channel partner initiative. Vetting potential IPAs for outreach purposes.

When recruiting multiple docs, NACO assists with formation of ‘POD’. How defined? Filing required. Maybe role for regional PODs or eve ’super PODS’.

When they get participation letter, who do they call? No specific name listed. Now only directed to general phone number.

SNF Rollout. Primary scope is 3 day SNF waiver portion. Tracking referrals and performance needs improvement.

Remainder of agenda included: Referral tracking and management vendor options, telehealth update, AWV proposal plan given 27.8% completed 2017 v. 21% in 2016 performance and target at 70-80%.

ACOs that incentivize AWVs show shared savings. Need see ROI on internal vs. outsourced AWVs.

1:20 PM Meeting with Operations Manager for update

Status of group recruitments in California, Colorado and other regions.

Worked on letter on ’physician recruitment’ upsides of participation.

Review responses to RFP for IT vendor replacement.

Review of marketing and communication efforts including social media activities.

3:30 PM

Conference call with IT vendor RFP consultant, with status vendor submission ratings.

4;30 PM

Free flowing debrief with Dr. Berger on day’s wide ranging and non-stop series of activities. Included question of whether or not to re-do a previous broadcast of This Week in Accountable Care which experienced some audio quality issues due to the moderator originating the broadcast from BIO International Conventions media center.

5:30 PM

Calling it a day, Dr. Berger drops me off at my car.

Comment

It’s very clear to me that managing an institutionally ‘untethered’ and physician led ACO – while more agile, if you will – is none-the-less a complex and challenging affair. There are many moving parts and with multiple parties coming into and out of key management decisions – both virtually and ‘IRL” – with all the attendant people and systems’ challenges, keeping focused and moving the enterprise forward takes constant vigilance.

When you add the complexity of the volume-to-value transformational imperative into the successful operation and scaled growth into the enterprise agenda, you begin to get a picture of what Dr. Berger, his physician colleagues and administrative staff face on a daily basis.

When you add the advantages (and associated duty to leverage them in support of the elusive triple aim) afforded by CMS specific to Next Generation Models such as National ACO, that complexity takes on an additional duty of care to manifest the ambitious but worthwhile mission of transforming U.S. Healthcare from a volume driven system to one that materially embraces a value based and outcomes oriented future.

My hat is off to this ambitious physician enterprise!