5 must-haves for success in CMS' MSSP ACO program.
In late January of this year, CMS released preliminary performance results from the first year of the Medicare Shared Savings Program. In brief, the results for the 114 MSSP participants are as follows:
- 109 satisfactorily reported on quality measures
- 54 had spending below their budget benchmarks
- 29 reduced spending enough to qualify for shared savings[1]
These results indicate forward momentum — but they also show just how much work participating accountable care organizations must still do to generate shared savings.
So what do Medicare ACOs need to do to succeed in years 2 and 3 of the program? Simply put, they need to improve quality performance, not just report on it. They need to empower frontline clinicians with tools for managing their patient populations, not just give them data.
The industry as a whole agrees that population health management is key to the success of ACOs and other value-based initiatives. Bending the cost curve requires care teams that interact daily with patients to identify at-risk cohorts and manage their care proactively. It is the care team that must be empowered to drive improvement — to measure and monitor quality across multiple initiatives and engage patients.
The following are five strategies for empowering the care team to improve quality and lower costs.
1. Validate the data
Good data is the foundation of successful population health management at the practice level. If the care team's actions are to be guided by the data — and their performance evaluated based on that data — they must be able to trust it. Significant work on both the back and front ends is required to ensure that data is reliable. On the backend, you must have a technology solution that can, for example, attribute the right patients to the right providers. On the frontend, you must ensure that every member of the care team is trained to document data consistently in the EMR.
2. Encourage provider involvement and transparency on quality reports
Driving the cultural transformation from fee-for-service to value-based care requires significant leadership, not only at the executive level but also at the practice level. You must identify clinical and nonclinical champions in the practice who will nurture a sense of accountability for change management among the care team.
Effective practice leadership eliminates the top-down approach to quality improvement where executives send reports to the practice that set off a quality fire drill. Such a top-down approach to showing care teams where improvement is needed can take on a punitive tone. By involving the care team directly — empowering them not only to run the reports but to take the steps necessary to fill quality gaps — you create a culture of improvement. In this kind of environment, transparency around quality gaps becomes a learning experience for the whole team and a positive motivating factor that encourages better care.
3. Automate care gap identification and patient outreach
Automating the process of identifying gaps in care among the patient population is a huge step toward empowering the care team. Many of these care teams — despite their efforts to create manual reports or reconcile health plan reports with their own data — don't even know how many diabetics are in their population, let alone the number of those diabetics who haven't had a recent A1c screening. With the right technology infrastructure, care teams can have that information at their fingertips with the click of a mouse.
Once these patients are identified, the care team needs a way to reach out to them automatically. Sitting at the phone calling patients to come in for an appointment is not the best use of a valuable care manager's time. By automating outreach, you can ensure timely contact via phone, email or text, while freeing up care managers' time for meaningful interactions with patients.
4. Identify care management priorities using risk stratification technology
Busy care teams aren't always able to identify which patients are high risk, which are medium risk and which are trending toward high risk. Empowering care teams with tools that automatically stratify the patient population is a critical aspect of effective population health management. Stratification enables the care team to prioritize their patient outreach and prevent catastrophic care events.
5. Engage below the waterline
Envision your patient population as an iceberg. The portion of the population above the waterline includes those patients that already suffer from advanced illness. You can't consistently reduce the overall cost of care for a population by just managing this small percentage of patients at the tip of the iceberg. You must engage the groups of patients who fall below the waterline — those with multiple chronic diseases, those at risk for disease and those who are currently healthy — before their health declines. To reduce cost and utilization over time, your care teams must focus on prevention.
Scaling care management is a high priority for ACOs looking to bend the cost curve and share savings. Empowering care teams to engage patients and manage populations will give you the best chance to achieve those goals.
Karen Handmaker, MPP, is vice president of population health strategies for Phytel.