Medicare Shared Savings ACO Trio Shares Keys to Success

The top performers in the Medicare Shared Savings Program are leveraging their experience with population health and their willingness to embrace innovation.

The pathways to shared-savings success are becoming clearer.

Houston, TX-based Memorial Hermann Accountable Care Organization and Portland, ME-based MaineHealth Accountable Care Organization are two of the most successful MSSP participants in the country. Executives at these ACOs say their organizations have been able to earn millions in MSSP shared-savings payments based on lengthy experience in population-health initiatives and wise investments in new capabilities.

"One of the reasons we have been so successful is this is not a new conversation for us," says Christopher Lloyd, CEO of Memorial Hermann ACO.

Memorial Hermann ACO's financial success as an MSSP participant is impressive, with the organization posting shared-savings payments in the federal program's first and second performance years, according to Centers for Medicare & Medicaid Services data. In Performance Year 1, which reflects data collected from 220 MSSP ACOs in calendar year 2013, Memorial Hermann ACO served 34,430 Medicare beneficiaries and earned shared-savings payments totaling $28.3 million. In Performance Year 2, which reflects data collected from 333 MSSP ACOs in calendar year 2014, Memorial Hermann ACO served 40,911 Medicare beneficiaries and earned shared-savings payments totaling $22.7 million.

The Memorial Hermann health system, which features 13 not-for-profit hospitals and about 5,500 affiliated physicians, was well-positioned for MSSP participation when the organization launched its ACO in July 2012, Lloyd says.

Having clinically integrated hospital and physician networks has been "absolutely fundamental" to Memorial Hermann ACO's success, he says. Prior investments in establishing patient-centered medical homes also have boosted MSSP performance. "That's the foundation. [Our primary care physicians] understand the concepts of cost and quality."

On the hospital side, Memorial Hermann ACO has sought to maximize value for both inpatient and outpatient services, driving down costs while maintaining quality in areas including supply chain and pharmacy.

"It helps us manage the total cost of care. We're pretty sophisticated at determining total cost of care, but we're not sophisticated enough yet. … We're calling it medical economics: understanding total cost of care and where the spending occurs," Lloyd says.

Strengthening the capabilities required to track total cost of care has been a top priority at Memorial Hermann ACO and throughout Memorial Hermann health system, he says. "The fastest area of investment is in medical economics." Those investments have included information technology upgrades and hiring a range of data-oriented staff members such as actuaries and data analytics specialists. "It is a whole series of people who have not been in the health system before."

Next month, Lloyd and a half dozen other Memorial Hermann executives are slated to provide a three-hour online presentation about the health system's ACO prowess.

MaineHealth ACO, which has an independent board, but is staffed through the Maine Medical Center Physician-Hospital Association, is built on a solid foundation crafted over the past two decades, says Betsy Johnson, MD, who serves as CEO of MMCPHO. She is slated to serve in a similar leadership role at MaineHealth ACO as part of a reorganization set to be finalized in January.

Since joining the MSSP program in July 2012, "We've evolved with the times," she says. And it's been lucrative.

Along with Memorial Hermann ACO, MaineHealth ACO was among the Top 10 MSSP shared-savings earners in Performance Year 1, serving 48,273 Medicare beneficiaries and receiving shared-savings payments totaling $9.4 million. The ACO did not realize an MSSP return in Performance Year 2, serving 49,413 Medicare beneficiaries and falling $831,000 short of the benchmark for receiving shared-savings payments.

"Because of our success in Year 1, and our ability to hold steady in Year 2, we get asked a lot about the reasons for our success," Johnson says. "We point to the existing infrastructure that we had in place."

The crucial component of MaineHealth ACO's existing infrastructure has been the physician-hospital organization MMCPHO, which has been in existence for more than 20 years. MMCPHO has experience providing care management as well as teams dedicated to care transitions, service contracting and data analytics. MMCPHO also had a clinical registry in place long before the launch of MaineHealth ACO, which provided an essential building block for population-health success, Johnson says. "We already had 10 years of experience in building our own registry."

Jen Moore, who serves as chief operating officer of MMCPHO, says expanding the physician-hospital organization's care management capabilities has bolstered MaineHealth ACO's performance significantly. "We had really been focusing on chronic disease management," she says. MMCPHO formed a care management team in 2003 to help treat patients with conditions such as diabetes and mental health disorders. "We needed to be in a different space for complex case management."

One of the innovative areas where MaineHealth ACO has invested time and resources is improving relationships among the organization's 10 hospitals and the region's post-acute care facilities. The historical experience at the hospitals was akin to having acute-care patients "discharged into a black hole," Johnson says.

"A single care plan is our vision across the entire continuum of care," the practicing primary care physician says. "That's a care plan that is the patient's care plan that everybody has access to… We are all learning together."

Engagement with physicians, skilled nursing facility staff, and other caregivers is an essential ingredient of the MaineHealth ACO's "secret sauce" for share-savings success, Johnson says. "Ultimately, it's all about how you engage the frontline team."

Minnesota-based ACO Embraces Innovation
Primary care is the prime focus of St. Paul, MN-based Community Health Network from top to bottom, says Paul Berrisford, MBA, a member of the MSSP participant's governing board and chairman of the ACO's finance committee. "Our ACO is primary care-driven. It is not your typical hospital-driven ACO."

Launched in January 2013, Community Health Network (CHN) was formed as a partnership between HealthEast Care System, Entira Family Clinics and two dozen specialty physician practices. The ACO's 12-member governing board has four representatives each from HealthEast and Entira, three representatives from the specialty practices, and one patient representative. "It was built around the concept of collaboration," Berrisford says.

The ACO has only four hospitals, all owned by HealthEast. "The patients get the care they need when they need it, which is easier said than done. … We use the ACO as the platform by which to do this and avoided the regulatory problems that come with collaborating with competitors."

With 13,553 Medicare beneficiaries in MSSP Performance Year 1, CHN earned $1.4 million in shared-savings payments. With 15,021 Medicare beneficiaries in Performance Year 2, the ACO earned $5 million in shared-savings payments.

So far, CHN has invested about $800,000 annually to build up its population-health capabilities, Berrisford says. That level of annual spending could rise to as high as $3 million to hire care managers and to staff a care transitions team. "We invested a substantial amount of resources in data analytics… In this year's budget, we will probably invest substantially more resources to care coordination and care management."

Another key investment for CHN has been contracting with Des Plaines, IL-based Pharos Innovations to provide telephonic and online patient engagement services. "We had a challenge… Population health is like looking at a matchstick from 50,000 feet," he says.

CHN has leveraged Pharos algorithms, data-gathering capabilities, and personnel to help provide care management to patients in several costly condition categories, including congestive heart failure and complex diabetes cases. "It made the focusing of our resources on those patients very efficient," Berrisford says, adding that CHN was able to limit the number of care-management phone calls to congestive heart failure patients from potentially 2,000 calls per day to about 20 per day.

The CHN leadership team is deeply committed to providing value-based care, he says. "We are evangelical about change. We don't think it can happen fast enough… It's better for us to do it to ourselves than wait for someone else to do it to us."

HealthLeaders Media LIVE from Memorial Hermann: A Care Management ACO, will be broadcast on Wednesday, November 11, 2015, from 11:00 to 2:00 p.m. ET. Memorial Hermann reveals its multi-pronged approach for their successful Accountable Care Organization. How physician alignment, patient engagement methodologies, and a focus on community health has propelled them to the top.