Strategies for Success: Insights From Top Performing ACOs

As some accountable care organizations struggle to succeed in quality measurements and others look to further improve their metrics, a panel of leading accountable care organizations (ACOs) shared lessons learned and best practices for ensuring compliance with quality measures while keeping the patient at the forefront during a session at the National Association of ACOs.

The panel included representatives from Novant Health Medical Group, Hattiesburg Clinic, and Aledade, and while each ACO had unique approaches to improving care and cutting costs, some overlapping initiatives emerged, most notably the Medicare Annual Wellness Visit (AWV).

The AWV—which is now completely covered by Medicare—represents an ample opportunity for improving the health of patients. These visits allow for identification of outstanding health maintenance needs; prevention, early detection, and slowing progression of chronic conditions; and enhancement of the patient provider experience, explained Kimberly Nunnally, director of government programs at Novant Health, which encompasses 15 hospitals and more than 350 physician practices throughout North Carolina, South Carolina, and Virginia.

AWVs also lower healthcare utilization and costs, with Novant Health observing an inverse relationship between these visits and emergency department and inpatient visits, she said.

Hattiesburg Clinic, one of the largest physician-owned, multispecialty clinics in the Southeast, has also utilized AWVs to promote value-based care, said Dan McCall, MD, endocrinology, diabetes & metabolism specialist, who explained how the ACO expanded the care team in order to offer more of these visits. By tapping into the capabilities of skilled registered nurses, Hattiesburg Clinic saw their number of AWVs increase from 803 in 2013 to 11,918 in 2018. And what’s not seen in that number increase is the increase in quality of care delivered to patients, said McCall.

This was key to changing the culture of the clinic, said McCall, who added, “Those nurses serve as the ambassador and translator. They’ve helped us close some siloed-type thinking and they help our organization to implement value-based care strategies.”

Annette DuBard, MD, MPH, director of clinical strategy at Aledade, which manages 21 MSSP ACOs comprised of more than 4000 providers across 24 states, echoed her 2 fellow panelists, citing a study she co-authored that was published in the March issue of The American Journal of Managed Care^®. The study examined the association of an AWV with healthcare costs and clinical quality measures among 8917 Medicare beneficiaries attributed to 44 primary care clinics participating in 2 ACOs. The study findings revealed significantly reduced hospital spending, a 5.7% reduction in adjusted total healthcare costs, and 70% higher screening rates.

The panelists also agreed on the value that data and dashboards bring to the practices within their ACOs. Using data allows practices to isolate the most important opportunity for intervention, communicate what they’re going to do about it and why, and engage in focused improvement efforts, explained Dubard.

At Hattiesburg Clinic, the ACO created a dashboard for providers to be able to follow individual value-based contracts and look in to each measure specifically, which is essential for being able to identify any gaps in a measure. “It’s difficult to close a gap you don’t know exists,” said McCall, who explained that this technology is particularly helpful as the number of quality contracts grows and the number of quality measures grow with it.

DuBard also emphasized that while hitting these quality metrics is important, “the work of the ACO is not to get an A+ on the quality report; it’s truly about getting the waste out the system, making our system affordable, and improving the well-being of our patients and bringing the joy back to primary care practice.”

“Our message is that the work of the ACO is this sweet spot of what’s good for providers, what’s good for patients, and what’s good for society,” she added. “The work of the ACO is bigger and better than measurement scores.”

Another initiative highlighted by the panel included physician compensation models, which reward physicians for improving patient outcomes. Rhonda Smith, BSMT, CPC, value-based performance coordinator, Novant Health, explained that these models include some measures of productivity; have goals that are SMART (specific, measurable, attainable, relevant, and time targeted); can be administered utilizing no more than the current resources; and ensures that physician compensation is a positive factor in recruitment and retention.

Offering evidence that these initiatives and others reap benefits for quality measurements, McCall explained that Hattiesburg Clinic in 2017 scored 100 on their MIPS quality score, resulting in the maximum +1.88% adjustment for 2019. For Aledade, 15 of 16 ACOs in 2018 improved their performance or maintained the 90th percentile in at least 8 electronic health record-based measures.