Frank Ross
CIO, Cumberland Center for Healthcare Innovation
ACO Performance Model
Increase Revenue while Building for
Value Based Care
Value Ahead
Overview of our ACO
Cumberland Center for Healthcare Innovation (CCHI)
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Located in Cookeville and the surrounding areas of Middle Tennessee.
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July 2012 Start Advanced Payment MSSP ACO with approximately 12,000
attributed beneficiaries.
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28 rural independent primary care practices and 39 physicians.
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CCHI achieved $4,732,231 in savings in 2013, and improved average quality
scores from 62% to 74% between 2012 and 2013.
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Collaborative accountable care initiative with Cigna in January, 2014 that is
benefitting more than 2,900 beneficiaries who receive care from among 37
independent CCHI physicians.
Presenter Bio:
Frank Ross is the Chief Information Officer for the Cumberland Center for
Healthcare Innovation, and the practice manager for Ross Family Medicine, one
of the CCHI primary care practices. Mr. Ross was a key leader in the
Challenge
Engaging Practices in ACO Compliance
Reporting
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Disparate clinical data: multiple EMRs
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Provider literacy on the ACO Measures
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Incomplete EMR documentation workflows
Solution
Innovating the Reporting Process
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Cloud-based reporting tool
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Pre-populate with claims & EMR data
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Attribution logic: match patients &
providers
• Review collection of data by metric • Collect data directly from your EMR
or enter into the Clinigence system • Determine when EMR data is
populating to complete data set
Clinigence Collection
Dashboard
Clinigence Quality
Dashboard
• Track and Monitor CQMs
• Extraction of EHR Clinical Data • Pre-populate CQM for Reporting
Clinigence Cost &
Utilization Dashboard
• Claims Detail and Summary
• Cost Center View
From Compliance Reporting to Care
Management
Use GPRO reporting scores to identify
care opportunities
Leverage fee for service to fill gaps in
care
Improve ACO process scores for the
clinical quality measures
ACO Process
Scores
Population
Management
Challenge
Resources for Care Management:
•
Practices lack
FTE’s and financial
resources to broaden care
management
•
ACO-wide tracking of care
management activities is fragmented
•
ACO Shared Savings is an elusive
goal
Solution
Leverage CMS Fee for Service
•
Identify and fill gaps in care;
E&M visits, screenings, labs, tests,
& procedures
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Medicare Annual Wellness Visits
(AWVs)
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The new Medicare Chronic Care
What about Gaps in Care?
Statistically, patients in the US only receive
55% of recommended preventive services.
Why?
Physicians don’t have time and resources to
manage them. Estimates suggest that a primary care
physician would spend 21.7 hours per day to provide all
recommended acute, chronic, and preventive care for a
panel of 2,500 patients.
If only 10 more patients per month completed: the
standard preventive lab testing, a mammogram, a bone
density scan; and one more patient per month had a
colonoscopy, this equates to increased monthly billing of:
Gaps in Care – Getting Started
Shift Activities to outside of the face-to-face visit
Perform pre-visit planning to maximize Provider
resources
Utilize Nursing and Medical Assistant staff
Activities count toward Chronic Care
Management (CCM)
Combine with Care Coordinator duties
Combine with Clinical Quality Measure (CQM)
activities
Gaps in Care
• Patient centric view that lists allmeasures for which there are gaps
• Can sort registry by column header • Export to excel for further analysis
Clinical Data for Patient Stratification
• Color coding indicates patient
ranking by gaps in care
• A new way to risk score a population • Useful in Care Management programs
Patient Centric Risk Scoring
• Apply customized alerts to high
priority gaps in care
• Integrate utilization history • View patient through the lens of
different programs (for example: MSSP ACO and Commercial ACO)
Medicare Annual Wellness Visit
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Every Medicare patient is eligible; no co-pay
no deductible
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2015 average reimbursement for the AWV is:
Initial=$172, Subsequent=$111
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Billable once every 12 months
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Comprehensive & personalized care plan
Chronic Care Management Code
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$40 PMPM for 20 minutes of Chronic Care
Management for patients with 2+ chronic
conditions
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Identify patients with “triggers” in the EMR that
indicate they have already received CCM
service activity
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Leverage Care Plans from the AWV
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Ongoing Maintenance of Care Plans
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Use CCM to fill gaps in care
CCM Dashboard
• Registry of patients eligible forCCM
• Lists chronic conditions per
patient
• Identifies documentation in the
EMR that indicates that CCM activity has likely taken place.
Let’s do the Math
The average primary care practice in the US has
2,300 patients
16% of them are Medicare
69% of Medicare patients have 2 or more chronic
conditions
CCM:
2,300 x 0.16 x 0.69 x $40/month x 12 months =
$121,881 new annual revenue per physician
AWV:
2,300 x 0.16 x $111 = $40,848 annual revenue
Adding it Up
CCM = $121,881
AWV = $40,848
Gaps in Care = $96,000+
Total: $258,729
The million dollar question: does
this improve health?
Primary Care Coordination
Delivery Model
Better
Quality
Care Coordination Chronic Care Management Gaps in Care Annual WellnessCost to Quality Comparison
• Y axis - Average annual Medicare cost per
patient.
• X axis- Average quality percentile score
on 22 MSSP CQMs.
• Each dot represents a practice in the ACO. • Positive Trend line Indicates Higher
