CareMount’s Foundation for Accountable Care Organization Savings

June 04, 2020 - In CareMount Health Solutions’ first year as an accountable care organization (ACO) in Medicare’s Next Generation ACO Model, the organization was one of 38 participants to earn shared savings. That year, the New York-based ACO generated over $778,000 in incentive payments through the program while maintaining a high level of care quality.

CareMount’s success in the risk-heavy ACO model, however, did not come overnight – or within just a year. The ACO participated as a Medicare Shared Savings Program Track 1 ACO since 2012 before advancing to the Next General ACO Model six years later. During that time, the ACO built the foundation for ACO success.

“It takes a lot of infrastructure and a lot of investment in order to be successful under these programs,” Kevin Conroy, CFO and chief population health officer at CareMount, said in an interview with RevCycleIntelligence. “At CareMount, we made a commitment to this journey several years ago. It's not something that you can take lightly. You can’t flip a light switch and the next day you're ready for this.”

According to Conroy, CareMount has developed key building blocks for success: data and analytics, care coordination infrastructure, patient communication, and physician alignment and engagement.

Data and analytics

Alongside provider engagement and care management, IT and data analytics make up the three cogs helping providers succeed in the Next Generation ACO Model, according to CMS. For CareMount, that rings true.

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“It is essential to have data and analytics to manage your patients,” Conroy said. “You need to have the ability to put that data into a digestible form and deliver it to physicians and care teams at the point of care.”

Next Generation ACOs have a legacy of leveraging data and analytics tools to complete value-adding tasks, such as identifying gaps in care, improving care transitions, and supporting post-discharge programs. The tools have been key to tracking aspects of value-based care, such as knowing when a patient ends up in the hospital or emergency department and even monitoring the ACO’s financial performance.

But getting that data into the hands of physicians has been paramount to CareMount’s success in the Next General ACO model.

“You need to support your physicians in terms of understanding this data and how they might approach taking care of that patient on a real-time basis in a proactive way,” Conroy said.

Implementing the right analytics tools and presenting the information in a manner that actually influences care delivery is an investment, Conroy acknowledged. However, it is one that is necessary and worthwhile for providers engaging in any value-based care programs.

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“I recognize that's an expensive investment for a lot of groups and it doesn't come easy. You need a good technology partner as well as the human capital from an analytics perspective in order to be successful,” Conroy said.

Care coordination infrastructure

Care coordination is at the heart of the ACO model, and CareMount has relied heavily on its care coordination infrastructure to improve care quality and realize savings as a Next Generation ACO.

“They [providers] need to be supported by care coordination units because the physician cannot and should not be in it alone,” Conroy said.

CareMount operates a Care Coordination Program, which works with chronically ill patients to engage them in their healthcare journey and provide personalized care targeted to the patient’s specific healthcare needs and issues.

“They're our mainline communication to our patients with chronic conditions,” Conroy explained. “We make sure that we're reaching out to them, being proactive about when they're discharged from the hospital, and ensuring that they get back to their primary care practitioner in a short amount of time.”

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Care coordination teams at CareMount also include hospitalists embedded in skilled nursing facilities, a major source of spending and quality variation for ACOs.

“Our robust care coordination team understands different aspects of reducing costs and improving outcomes. One example is discharge planning and another is transitions of care,” Conroy stated. “They also impact emergency room utilization.”

Care coordinators and others on the team influence care quality and spending by asking important questions. Are there alternatives to avoiding frequent ED utilization? Is there a way to get patients to a more appropriate setting to avoid unnecessary utilization?

Once those questions have answers, relaying that information to providers helps CareMount direct patients to the most clinically appropriate – and cost-effective – pathway for care.

Patient communication

Patient engagement is another pillar of the Next Generation ACO, which tests whether tools that support patient engagement and care management can improve health outcomes and lower costs. To achieve the right level of engagement for success in the model, CareMount has implemented a patient communications strategy.

“There are various means of communicating with our patients, particularly those who are afflicted with a significant amount of chronic disease challenges. We focus on them as a part of a larger cohort and approach,” Conroy said.

Care coordinators and other providers dedicated to patients support communication efforts, especially for the chronically ill. But like many ACOs, CareMount has also reached out to its patients via its patient portal, website, and other communication channels to help patients stay healthy.

Patient communication and outreach have been pivotal to Medicare ACO success, with some organizations creating positions specifically tasked with addressing patient engagement for the ACO. Other ACOs have implemented technology to nudge patients when they are due for care.

And these efforts have helped patients not only overcome healthcare-specific challenges, but also other barriers to care in their lives, such as a lack of transportation to the doctor’s office.

Physician alignment and engagement

Physician alignment and engagement solidifies the foundation for CareMount’s success as a Next Generation ACO, Conroy reported.

“[You need] physicians who understand value-based care, such as the importance of an annual wellness visit, performing well in quality and patient satisfaction areas, and understanding the importance of comprehensive documentation and coding and programs such as HCCs,” Conroy explained.

“Those are the physicians who drive our chronic care initiatives, including end of life, diabetes, and hypertension management programs. Those types of programs are key to taking better care of the patient and improving outcomes.”

It is no surprise then that provider engagement is one of the cogs CMS has identified as a driver of Next Generation ACOs. ACOs need to ensure their physicians and other healthcare professionals are actively engaging with the value-based payment model. For example, providers need to directly take on more risk for patient outcomes in order for risk-based ACOs to be successful, the agency explained.

“Tying compensation to the value-based program’s initiatives and goals is a critical component,” Conroy agreed. “Put dollars in places that incentivize value-based care, such as the importance of that annual wellness visit, the importance of access, the importance of timely follow-up. All those pieces are essential to align from a compensation perspective.”

While the Next Generation ACO Model is coming to end, with the program receiving a one-year reprieve due to the coronavirus pandemic, the foundation for ACO success laid by CareMount will not be for naught. The ACO will continue to commit to value-based care through other initiatives, like Medicare’s new Direct Contracting opportunity.

“Whether we go to direct contracting or some other value-based program, we feel CareMount is ready,” Conroy said. “The programs we have developed to be successful under Medicare, are applicable across all of our patients. We plan to extend these programs to all of our patient populations over time.”