5 Takeaways From the ACO Coalition Fall 2016 Live Meeting

At the fall live meeting of the ACO & Emerging Healthcare Delivery Coalition™ in Philadelphia, Pennsylvania, attendees heard presentations and participated in workshops that discussed care management, value-driven payment systems, and the future of healthcare. The spring live meeting of the ACO Coalition will be held May 4-5, 2017, in Scottsdale, Arizona.

Here are 5 takeaways from the 2-day fall meeting, which was held on October 20-21, 2016. For full coverage, visit the conference page.

1. MACRA was on everyone’s mind

Unsurprisingly, Coalition attendees were buzzing in reaction to the highly anticipated Medicare Access and Chip Reauthorization Act (MACRA) final rule that had been released less than a week before.

James M. Daniel, Jr, JD, MBA, presented a session on MACRA’s implications from his perspective as a healthcare attorney at Hancock, Daniel, Johnson & Nagle, PC. He said that while most providers are glad to see the old sustainable growth rate gone, they might be confused about what is expected of them under the new rules.

The following panel discussion explored how accountable care organizations (ACOs) could help providers understand and adjust to the new payment system. Travis Broome, MPH, MBA, healthcare policy lead of Aledade, Inc, said that for many physicians, “A lot of it boils down to ‘What am I being scored on and why?’”

MACRA resurfaced in several interviews with AJMC as well. Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS, explained the “pick your pace” provision. Katherine Schneider, MD, president of the Delaware Valley ACO, gave examples of how DVACO has helped physicians get a head start on implementing MACRA by “laying the groundwork” for success.

2. Hotspotting could help reach complex patients

Three speakers from the Camden Coalition of Healthcare Providers brought their expertise across the river to Philadelphia, where they explained how their ACO uses hotspotting to target the most complex and costly patients.

The Care Management Initiative (CMI) was presented by Renee Murray, associate clinical director of the program, and Andrew Katz, senior program manager. The CMI team of social workers, health coaches, and nurses visit each patient at home, learn about his or her situation and priorities, and empower that patient to achieve self-identified goals in these domains, which are often not strictly medical.

“We're not just going to laser in on one disease state, we're taking everything that's making up this person into account,” Murray explained in an interview with AJMC.

Natasha Dravid, MBA, associate director for business planning and continuous improvement at the Camden Coalition, then took the stage to describe the 7-Day Pledge. It targets patients who have been discharged from inpatient care with the goal of them seeing a primary care physician (PCP) for follow-up within 7 days. Through close cooperation with local PCPs, the program created a reimbursement program that rewards both providers and patients for each prompt follow-up.

3. ACO characteristics may be correlated with quality in some surprising ways

ACOs of all shapes and sizes were represented at the Coalition, highlighting the diversity of this care model. Mariétou Ouayogodé, PhD, a post-doctoral research fellow at the Geisel School of Medicine at Dartmouth, kicked off the coalition with the first session, “Associations of Organizational Characteristics with Performance: Disease Prevention Measures.”

She presented her data on how ACO qualities (like size, composition, organizational structure, beneficiary characteristics, and more) are related to their success, based on a sample of 215 Medicare Shared Savings Program (MSSP) and Pioneer ACOs.

Financially, no single factor predicted the amount of savings, but Ouayogodé did find that ACOs with prior risk-bearing contracts were more likely to receive bonus payments. She attributed this correlation to the knowledge and strategies ACOs can acquire in a risk-based environment. Additionally, although many ACOs with different compositional types were equally likely to achieve savings, those with large baseline financial benchmarks had more opportunities to succeed.

Ouayogodé’s research also explored the impact of ACO characteristics on the quality of preventive care. She found that high performers had fewer specialists, were more likely an MSSP or an alternative payment model (APM), and had a higher ratio of beneficiaries to full-time primary care providers. The only factors that had negative associations with care quality were a high number of specialist providers and a high quantity of minority beneficiaries.

4. Patient engagement must be higher up on the priority list

Patients will become more and more engaged in their healthcare, and providers must welcome and encourage this development, according to Eleanor M. Perfetto, PhD, MS, senior vice president of Strategic Initiatives at the National Health Council. She said that in a patient-centered system, the patients’ views are given credibility, so providers must “start to set up mechanisms to listen to the voice of the patients you care for.”

A. Mark Fendrick, MD, director of the University of Michigan’s Center for Value-Based Insurance Design and co-editor-in-chief of AJMC, agreed that patients will take a more active role in their healthcare, and thought that rethinking benefit designs could make this transition smoother. He said that the incentives for providers need to be aligned with those of their patients. In the current system, he estimated that 80% of providers are not aligned with their patients, 19% don’t know what the patients want, and only 1% say, “let’s make it easy, not hard, for the patients” to be more engaged.

The Camden Coalition of Healthcare Providers served as an excellent example of how to meaningfully engage patients. When the CMI team visits a patient for the first time, they begin the process of care planning, where they ask what the patient wants to work on instead of focusing on a medical diagnosis. Often, the patients mention worries like housing insecurity, legal troubles, or lack of social support. The team helps to resolve these concerns because the patients cannot become fully engaged in their healthcare if they are preoccupied by more pressing struggles.

5. Keep a cautious eye on the future, stakeholders say

The “Healthcare 2020” panel concluded the meeting by bringing together experts from various components of the healthcare system and asking them to imagine how it might change in the coming years.

Perfetto and Fendrick joined Michael E. Chernew, PhD, director of the Healthcare Markets and Regulation Lab at Harvard Medical School and co-editor-in-chief if AJMC, to discuss the future, including the upcoming presidential election. They agreed that regardless of the outcome, the ACA faces serious challenges, especially if the healthcare exchanges fail. Perfetto added that a collapse would affect not just those who lose coverage but every patient concerned about high out-of-pocket costs, deductibles, and copays.

The contentious political environment was cited as a huge barrier to the ACA’s success. Chernew said that despite political resistance to “Obamacare” in conservative states, the economics “unquestionably favor” Medicaid expansion.

Chernew and Fendrick also worried about the future of the ACO model, agreeing that although ACOs have seen some promising results in savings, the healthcare system might move on to a new system and leave ACOs in the dust.

“We’re impatient,” Chernew said. “Before we make things work, we move to a new thing.”