By Diane Blackburn
Our accountable care organization (ACO), Prime Accountable Care LLC, based in Southfield, Michigan is one of the 561 participants this year in the Medicare Shared Savings Program (MSSP). Prime Accountable Care is unique because we are not part of a large, integrated health system, but rather comprised of more than 150 independent primary care physicians and mid-levels in Metropolitan Detroit and throughout Michigan.
Our ACO, however, is like many others in that we face the challenge of trying to manage and derive meaningful quality and cost insights from the huge amounts of data sent to us from the Centers for Medicare and Medicaid Services (CMS). Until 2016, we thought we had solved the challenge because we were using a population health management (PHM) platform that was analyzing the CMS data and delivering reports that showed we were on track with our care-quality and cost-savings goals.
It turns out, however, the PHM platform was delivering inaccurate insight, causing us to maintain the status quo for several months that we could have spent improving our key performance indicators (KPIs). Fortunately, in late 2016, we switched to The Garage, which presented accurate and reliable analysis of our care quality and cost performance. We ended up receiving a 100 percent rating from CMS on our quality performance in 2016, which we extended into 2017 while reducing our costs by millions of dollars.
Crossing over to the Bridge
Since we are a Track 1 participant in the Shared Savings Program, we do not risk incurring losses if we do not meet our savings goal, but we would lose out on any additional revenue from that shared savings. The problem was we couldn’t track those goals with our previous PHM because, apart from the inaccurate reporting, viewing our per-member-per-month spending was difficult if not impossible.
After we ended our contract with the previous vendor, we attended a conference to find not just another software vendor, but a partner to help us get back on track. We reviewed proposals from 40 companies and narrowed it to four who we interviewed at length. The Garage stood out as a true partner who listened, understood our challenges and demonstrated actionable results.
Once The Garage’s PHM platform, The Bridge, was implemented in November 2016, the insights it delivered were startling in some cases, just in time for 2016 reporting. For example, we found groups of high-risk patients attributed to our ACO who, unbeknownst to us, had visited the emergency department (ED) more than 20 times in the past year. Through Bridge, we were able to view this ED data from across our ACO, and drill down to the practice and physician level so interventions were more targeted and effective.
As business development director of Prime Accountable Care, I am part of a lean staff with many duties across the ACO. One of the things I appreciate most about The Garage and its Bridge platform is the easily accessible and actionable insight. In an instant from my dashboard, I can see how the ACO is performing across cost and quality KPIs, especially among high-risk patients with our most common chronic conditions such as chronic obstructive pulmonary disorder, congestive heart failure and diabetes. If a negative trend is emerging, we quickly identify the causes and work with the physician or practice to intervene with the patients or find another vendor that can help improve our performance.
Through the Bridge, our affiliated physicians are improving outcomes and increasing revenue through the Annual Wellness Visit module. It helps remind us when our MSSP-attributed patients are due for a visit where we can identify potential health issues or overcome care-plan adherence obstacles. We have also seen similar clinical and financial improvements among high-risk patients through chronic care management appointments delivered on The Garage’s Ignite telehealth platform.
Taking the next steps
This year, we are helping our practices become familiar with the Bridge’s Transitional Care Management module to better coordinate care and support patients’ recoveries as they move between different care settings, including home. We are also planning to launch The Garage’s predictive analytics engine so we can begin to intervene with some of our high-risk, high-need patients before a health crisis occurs.
We cannot imagine accomplishing any of our ACO’s care quality or financial goals without The Garage as our technology partner. In the coming years, as CMS and commercial-payer ACO programs become more demanding and data-intensive, we believe it will be impossible for any ACO like ours to succeed without such a partner.