The healthcare industry is moving away from fee-for-service into quality, outcomes-based financial models, but we’re not quite there yet.

For most providers, hospitals, and health systems, switching to a value-based model is a top priority. However, making the leap is easier said than done.

Since its inception in 2012, the Medicare Shared Savings Program (MSSP) has been met with limited success, with a minority of accountable care organizations (ACOs) meeting the goals of the program. CMS data shows that an estimated 134—or about 31 percent—of the 432 ACOs that participated in MSSP for the program’s fifth performance year generated shared savings in 2016.

In general, it’s safe to say ACOs, despite the benefits MSSP shared savings could bring, are having trouble meeting the goals of the program. Innovation Care Partners (ICP), an affiliate of HonorHealth, is among the small number of MSSP ACOs that have achieved outstanding cost savings and clinical outcomes, including a significant increase in quality scores from 60 percent to 97 percent during their three years of program participation.

ICP is a large, multispecialty physician-led clinical integration network (CIN) based in Scottsdale, Ariz. When it joined the MSSP program in January 2014, the organization had about 500 physicians at more than 150 practices with more than 40 EHR systems. Presently, ICP is home to more than 1,600 physicians at over 350 physician offices, covering more than 90,000 patients, through seven different insurance contracts including Medicare Advantage, commercial insurance and HonorHealth’s employee health plan.

The objective of ICP’s participation in MSSP was to improve the quality of care with the added benefit of gaining the maximum shared savings available from the MSSP. Its keen focus on physician engagement, innovative technology adoption, and coordinated care for patients are what led to its success, as these values are at the heart of the value-based success rewarded by MSSP.

Hurdles to MSSP success

When setting out to launch its MSSP ACO, ICP quickly met a number of challenges, including data access limitations – which included problematic data exchanges — and major hurdles with data gathering, informatics, and reporting. Additionally, cultural barriers exist in any organization this size undergoing a major change. As a result, challenges related to personnel also needed to be addressed early in the launch process.

A top priority was finding a solution that would make it easier to meet MSSP compliance and reporting requirements. Another crucial need was finding the right tools to facilitate data-sharing, identify patients most at risk, help clinicians close gaps in care, and simplify reporting on quality measures.

ICP needed to build an open health information exchange (HIE) platform that would collect complete, accurate patient data from high-value but disparate clinical data sources and make information available to its participating physicians. On top of that, they needed an analytics engine capable of creating a patient registry and a managed database. The engine needed to enable data consumption from clinical data repositories, enterprise master patient indices, ACO files and EMR imports. Lastly, they needed a solution to accomplish all of that functionality while providing a real-time dashboard for monitoring and tracking performance against the MSSP clinical quality measures.

Success Found in Technology

ICP approached Orion Health to develop an ACO-focused application to seamlessly integrate analytics into the reporting and monitoring workflows of all user types, making ACO compliance and reporting requirements easier to achieve.

The solution, tailored toward an ACO looking to successfully participate in MSSP shared-savings, offered several benefits:

  • An intuitive quality-measure checklist, which enables users to manually enter the specific patient data required by a quality measure
  • Configurable privacy rules, which ensure that users are only exposed to those patient records they’re entitled to view
  • The application enables the acceptance of clinical data from practices through CMS’ Group Practice Reporting Option (GPRO) format, exporting the results of the reporting period for the sample population in a CMS-ready report.
  • The application has supported ICP’s growth by reducing administrative costs and integrating with the Orion Health platform, which ICP has long used for its HIE and clinical portal. This further reduces manual data entry by allowing data from third-party systems (e.g., EMRs and reference labs) to be streamed in real time into the underlying ACO registry models.

The implementation of this MSSP management application simplified the reporting process, reducing the demands on practices’ staff and ensuring regulatory compliance.

Read the full article on the Healthcare Informatics site here.