Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

How Pioneer ACOs Earn Shared Savings, Improve Care Quality

A longstanding history with forms of accountable care enabled Atrius Health to earn shared savings as a Pioneer ACO.

By Jacqueline LaPointe

- Massachusetts-based Atrius Health successfully managed several care quality improvements over the previous year and earned both the recognition of CMS and a portion of shared savings as a participant in the Pioneer ACO Model program.

Atrius Health, a Massachusetts-based Pioneer ACO, attributed its financial and quality improvement success to its long history with accountable care

In August, CMS announced that two Medicare accountable care organization (ACO) programs – the Medicare Shared Savings Program and the Pioneer ACO model – generated over $466 million in healthcare savings in 2015, but there were some clear winners separating themselves from the pack.

While approximately half of the Medicare ACOs lowered their healthcare costs below their benchmarks, only 125 out of 404 ACOs qualified for shared savings reimbursements by reducing spending beyond a set threshold.

With nearly 70 percent of Medicare ACOs failing to achieve shared savings, CMS noted that more experienced ACOs were better able to realize healthcare savings and boost their performance scores compared to ACOs that finished their first or second performance year.

Atrius Health, a Pioneer ACO since the program’s inception, was one of those experienced ACOs and saved Medicare nearly $6.8 million in 2015, returning $4.4 million to the ACO in shared savings. The ACO was also one of the six Pioneer ACOs (out of 12 total) that qualified to recoup a portion of generated savings.

READ MORE: NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

CMS reported that Atrius Health achieved over a 95-percent quality score, scoring above the mean on 30 of 33 quality measures. For many of the quality measures, Atrius Health performed above the 90th percentile benchmark.

Much of Atrius Health’s financial and quality improvement success under the Pioneer ACO model can be attributed to the organization’s experience with alternative payment models and accountable care, Vice President of Population Health Emily Brower, MBA, recently told The organization’s experience with value-based care models made it a good fit for the Pioneer ACO model.

“Atrius Health has a long history of working with what we would now call alternative payment models in which we were accountable for the whole range of services that our patients received across the healthcare continuum,” she explained. “We had been working in an accountable care model in both commercial Medicaid and Medicare in the Medicare Advantage space. We had a lot of the infrastructure and support to provide that same kind of model for traditional Medicare patients aligned to us through the Pioneer ACO.”

Soon after joining the accountable care program, the organization started to identify the areas that presented the biggest opportunities to improve quality of care and reduce spending. With the help of the Center for Medicare & Medicaid Improvement (CMMI), the Pioneer ACO analyzed claims data to pinpoint gaps in care delivery.

“Participating in the Pioneer ACO program means that the ACO receives the claims data about all the care that the patients who are aligned to us receive, so we have this new sight line into all of the services that patients were getting, where those services were provided, and how much those services cost,” Brower went on to say. “Through that we are able to benchmark all of that activity both within our organization and our Medicare Advantage population. As CMMI started to pull together the Pioneers and benchmarked us against each other, we started to see where there were gaps in care and that’s where we started.”

READ MORE: CMS Calls On Rural Hospitals to Join Alternative Payment Model

With the claims data from CMS, one of the first things that Atrius Health noticed were significant differences in post-acute care across its clinical areas and among patient populations.

“What we saw with our Medicare Advantage patients was that patients were recovering sooner, getting home sooner, and were less likely to bounce back to the hospital,” Brower remarked. “We spent a little time looking at the data asking why might that be and we were really honing it on the fact that there was a subset of skilled nursing facilities that were outperforming others on quality.”

That led the organization to focus on getting the word out to patients about their options for choosing high-quality post-acute care services.

“We worked to create a network of those high-performing facilities,” she added. “We wanted to make sure that our patients were aware that these providers were a good choice for them to get post-acute care.”

Another initial area of focus was preventing unnecessary hospitalizations, Brower added. The organization worked to identity high-risk patients and developed a single plan of care for those individuals that spanned across the disciplines. Atrius Health wanted to make sure that patients were connected to their services and engaged in their own care to help prevent hospitalizations.

READ MORE: Coalition Offers CMMI, Alternative Payment Model Improvements

A key component to succeeding under the Pioneer ACO model and seeing quality improvements is collaboration, Brower pointed out. Atrius Health relied on CMS to communicate meaningful information on benchmarks and, in turn, the organization provided feedback to the federal agency on how to improve the model itself.

“With the folks at the Innovation Center, they produced benchmark data and they pulled together ACOs in shared learning webinars and collaboratives,” said Brower. “That benchmark data is very helpful. They also produced a dashboard. We were provided a lot of input into what are the kinds of metrics and data that an ACO would be looking for in benchmark information and how that data can be most helpfully displayed and parsed.”

Communication with other Pioneer ACOs and colleagues in similar alternative payment models also contributed to the ACO’s financial success, especially on measures that were unfamiliar to providers at Atrius Health.

“I’m frequently in touch with other Pioneer ACOs, whether it’s a quick call, a conference call, or we’ll get teams together on a webinar to share something we are struggling with and we are looking for ideas,” Brower stated. “Conversely, if we’ve had success on a particular initiative, then we share that with others.”

The culture of collaboration among Pioneer ACOs helped drive further innovation in care delivery.

“That’s really one of the best things about the Pioneer ACO model is that openness and willingness among Pioneers to share strategies, particularly around areas to improve care for the traditional Medicare fee-for-service population,” Brower reiterated.

For example, Brower observed that providers at Atrius Health were unfamiliar with how to measure falls risk. The organization started to implement the new measure by reaching out to other Pioneer ACOs and colleagues to ask them how they perform assessments and measurements of falls risk. Providers at Atrius Health also sought expert opinions from individuals who have published on the topic.

“We brought that the information back to the clinical teams and asked what do we think is the most important for us clinically in understanding falls risk in the elderly and how can we as a care delivery system put into place screening measures as well as interventions and clinical programs that identify and reduce risk,” Brower said.

Additionally, Atrius Health developed a culture that focused on continuous cost and quality improvement initiatives. For Brower, participating in an alternative payment model was about helping patients navigate a fragmented healthcare system rather than just reporting.

“We are always looking for the measures in which we could improve each year and when we get that benchmark data," she said.

“For us, it’s not just once a year when we’re going to go into the chart, pulling the measures, and putting them into the reporting tool. That is a small piece of what we do. We obviously need to report. We report well. But for us it’s really about the care that’s being delivered on which we are reporting and how do we make the work that we do around quality at the center of care, not something we do on the side,” Brower concluded.

Dig Deeper:

Understanding the Value-Based Reimbursement Landscape

What Are the Benefits of Accountable Care Organizations


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