Sticking with accountable care but strengthening its focus on population health, Franciscan Alliance moves to the Medicare Shared Savings Program.
Franciscan Alliance was one of the original members of the Pioneer Accountable Care Organization (ACO) pilot project, an initiative of the Centers for Medicare and Medicaid Services (CMS) supporting ACOs in providing more coordinated care to beneficiaries and lowering costs to Medicare in the process. The Pioneer model was unquestionably a successful approach for Franciscan. From 2013 to 2014, the 13-hospital chain based in Mishawaka, Indiana, saw a 6.6 percent decrease in overnight stays and a 430 percent jump in profits to $194.3 million.
Despite those positive results, the healthcare organization opted to leave the program this year. It moved to the Medicare Shared Savings Program (MSSP), another broad test of accountable care that launched in 2012 under the Affordable Care Act. The MSSP ties financial incentives to an organization’s performance on quality targets. An ACO that succeeds in meeting cost and quality standards keeps a share of its savings and, after the first three years, is required to pay penalties if it fails to save.
“Pioneer and MSSP are really similar,” says Albert Tomchaney, M.D., chief medical officer at Franciscan Alliance. “They both give hospitals opportunities to get involved with population-based care and evaluation. The difference is the level of risk you’re taking, and we just decided the MSSP was best for us.”
Making the Switch
As a large health system operating under a single tax identity, Franciscan Alliance was allowed to participate in only one of the ACO incentive programs offered by CMS. Franciscan leaders had intended to expand ACO practices to other facilities beyond the Indianapolis area by dividing physicians into two groups—one operating under the Pioneer agreement and the other under MSSP.
Forced to make a choice, the hospital system selected MSSP partly because it offered better opportunities to address provider risk, Tomchaney says. CMS is still working out some of the nuances regarding how patients get attributed to a particular ACO. Some systems attribute patients retrospectively, based on who was served in the past year, and others prospectively, assigning patients to a particular ACO for the coming year.
“Attribution has implications for how patients progress through the medical system, and some people prefer one model over the other,” Tomchaney says. “The important thing is that healthcare providers are treating all patients the same, irrespective of their attribution.”
ACO Advice for Other Facilities
A shared savings program like MSSP can be beneficial to healthcare organizations interested in providing population-based care. To capitalize on such programs, Tomchaney recommends the following:
1. Examine data sources. Before getting involved in a shared savings program, make sure you understand your data system’s ability to provide real-time information about care episodes. Because there is a time delay between providing care and receiving claims data from CMS, it can be a challenge to proactively manage patients. It’s hard to move forward when you can’t look in the rearview mirror.
Rather than relying on CMS claims data, Tomchaney recommends looking to internal systems for real-time information regarding when patients enter the hospital, undergo tests and receive treatment.
2. Make primary care a top priority. Successful ACOs work to engage patients in “medical homes,” ensuring they have access to primary care providers. In addition, a medical home should also utilize care coordinators or navigators to ensure patients are engaged and receiving needed services across the healthcare spectrum.
A care navigator may track various visits, schedule follow-up appointments, conduct after-visit planning, track medication usage and make sure information is transferred between primary and specialty care providers, Tomchaney says.
3. Focus on efficiency. The medical home approach attempts to reduce unnecessary emergency visits and hospital stays by directing patients to the appropriate venue of care. But it only works if providers are as efficient as they can be in all of those settings. That translates into adopting core clinical guidelines and establishing care maps to optimize the patient experience.
“Even if you’re working under shared savings programs, patients are still in a fee-for-service environment and can direct a lot of the services they want to receive,” Tomchaney says. “But with a care management team available to reach out and help them make decisions and coordinate care, you can achieve more appropriate use of services and reduce complications, which leads to savings.”
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