Succeeding in a Brave New World: the Maine Community ACO
Along with the changing foliage, school buses, and cool nights, a sure sign of fall (for inveterate policy wonks like me!) is the publication of annual results from the Centers for Medicare and Medicaid (CMS) Accountable Care Organization (ACO) demonstrations. CMS recently released results from Medicare ACOs 2015 performance year for ACOs nationwide, noting, “…over 400 Medicare ACOs generated more than $466 million in total program savings in 2015, accounting for all ACOs’ experiences. Of these, 125 qualified for shared savings payments by meeting quality performance standards and their savings threshold.” A helpful analysis posted to the Health Affairs blog noted great variability across ACOs, and identified several factors associated with success, including the length of ACO efforts, and the presence of physician-led and integrated ACO structures.
I was particularly eager to review results from the five Maine provider organizations participating in CMS ACOs, and was especially pleased to see that one group, the Maine Community ACO, passed the magic threshold of quality and cost results, qualifying for participation in nearly $1M in “shared savings” that will be distributed to their participating providers – a signficant reflection of their efforts, and a boost to the resources of the participating health centers that make up this primary-care based ACO. And while ACOs nationally aspire to achieve this level of success, experience shows that reaching the shared savings threshold is no easy task: of the approximately 400 organizations participating in the Medicare Shared Savings Program (MSSP) ACO demo, just over 25% (119) qualified to participate in shared savings by meeting quality standards and holding spending substantially below pre-set financial benchmarks.
Inspired by these impressive results, I quickly contacted leaders from the Maine Community ACO to get their perspectives on key factors contributing to their success. Established in 2012, the Maine ACO is a partnership of eight ACOs across the state and Universal American, a family of healthcare companies that provides administrative and data support. I spoke with Lee Umphrey, Executive Director of Harrington Familiy Health Center and Maine Community ACO Board Chair, and Jude Neveux, Executive Director of Maine Community ACO (MCACO), who shared the following thoughts on key factors they identify as contributors to their success:
- Know your patients: To succeed on both quality and finacial metrics, it is critically imporant for primary care clinicians and teams to know their Medicare patients – both the healthy and the sick! MCACO leaders stressed the importance of using the Medicare Annual Wellness Visit (AWV) as one strategy to establish (or re-establish) their relationship with patients and identify their health wishes, challenges, and needs. MCACO practices have adopted specific strategies to increase AWV rates, including tracking and regularly reporting AWV rates by practice; conducting direct outreach to patients; and hosting a competitive “AWV Challenge” across practice sites. Additionally, they noted the importance of identifying patients with particularly high levels of health care needs, including those with complex needs and signficant illness such as End Stage Renal Disease.
- Maintain a continuous focus on quality: MCACO leaders cited their commitment to maintain a continuous focus on quality throughout the year, and visibly linking this focus to improved patient outcomes. To support that effort, MCACO has invested in a customized data tool that helps providers track key quality measures at every patient visit, and provides reporting to monitor performance at the practice level. They also noted the value of using the AWV as an opportunity to conduct needed health screenings and deliver preventive care that can contribute to strong quality performance.
- Focus on high-risk readmissions as opportunity to improve quality and decrease costs: MCACO data indicated that two conditions, COPD and heart failure, were associated with the highest number of potentially avoidable hospital admissions and readmissions. They have developed focused efforts to identify patients with those conditions to improve their self-management skills, and have helped to support their transition across care settings. Additionally, some MCACO practice sites have added a dedicated care coordinator to proactively outreach to patients with those conditions, and provide hands-on support through the discharge process.
- Invest in site-level clinical leadership: MCACO recognized the importance of developing and supporting clinician leaders at the practice site level. They identify a clinician leader at each of their practice sites, and provide them with support and clear expectations for leading change. The clinician leader serves as a champion for quality data collection, linking the importance of quality data measurement with improving patient care and outcomes (“connecting the dots”), and serving as a bridge for communications with other members of the care team.
- Share best practices: MCACO leaders attributed a big part of their success to their commitment to learning and openly sharing their experience, successes, and best practices across practice sites. This includes transparently sharing data and quality measures, with sharing possible because of high levels of trust and confidence across the participating practices. Additionally, they noted that several MCACO practices have been active participants in the Maine PCMH Pilot and related learning events, including QC trainings, webinars, and conferences, and have worked closely with QC practice facilitator staff. Collectively, these efforts have helped to instill and inform patient-focused quality efforts at their health centers.
Maine Quality Counts applauds the efforts of the Maine Community ACO, and we look forward to additional opportunities to share more specifics about their strategies, practice changes, and lessons learned in the months ahead!
 Bucksport Regional Health Center; Eastport Health Care Inc.; Harrington Family Health Center; HealthReach Community Health Centers; Islands Community Medical Services; Regional Medical Center At Lubec; Sacopee Valley Health Center; St. Croix Regional Family Health Center; Quest Diagnostics Clinical Laboratories Inc.