We would like to thank everyone for:
1. NextGen ACO Acceptance and Advanced APM Status
The Alliance is now a participant in the Next Generation ACO (NGACO) Program.
For 2018, this is great news on several levels: (A) It puts the Alliance
in the Advanced APM arm of MACRA. Not only does this (B) exempt us from
increasingly onerous MIPS reporting but it also (C) provides access to
a 5% bonus to our providers on their Medicare Part B billings starting
in 2020. (D) The structure of the NGACO program is more conducive to the
Alliance taking home generated savings. (E) Attribution is prospective
which enhances our planning and care coordination activities. (F) There
are beneficiary enhancements available to us that provide opportunities
for more creative ways to promote the health and wellness of our patients
such as using telehealth services.
2. MSSP Quality Score and $3.7 million in Savings
The Alliance score in the quality component of the MSSP program in 2016
(otherwise known as GPRO) was 96.72. This was above the median score for
all the nation’s ACOs. Another great story to tell is that the Alliance
saved $3.7 million in the Medicare Shared Savings Program in 2016 and
$3.4 million in 2015. This reflects a lot of hard work by (1) our providers
actually getting the work done to meet these metrics and (2) the Alliance
staff collating and analyzing data and educating our providers. Kudos
to our practices for this accomplishment.
3. HCC Coding Efforts
Accurate and complete coding is an important component of the success of
the NGACO program and can enhance our success in value-based commercial
programs as well. Many of our efforts near the end of this year focused
on making sure we get recognized and reimbursed for the great work we
are doing in taking care of complex patients with multiple conditions
and comorbidities. By submitting the appropriate coding when billing for
our services, this documents to our third-party payors the complexity
and required resources needed for our patients. Our recent survey revealed
good participation in this coding effort for which we are grateful.
4. GPRO Reporting/MSSP and MIPS APM
2017 is our third and final year of participation in our MSSP Track 1 program.
Our MIPS APM status allows us to satisfy our MIPS reporting for 2017 as
a single entity. The Quality component will be satisfied by our GPRO reporting
which we have been doing annually and successfully for two years. Participation
in the Alliance earns you 100% of your CPIA (Clinical Practice Improvement
Activity) score in 2017. The Resource Utilization component has been waived
by CMS for 2017. The Advancing Care Information reporting requirement
(which replaces Meaningful Use) remains an individual practice responsibility
in the MIPS APM program.
5. Million Hearts Program
To date we have screened 8,600 Medicare beneficiaries and determined that
1,955 have a risk of at least 30% or greater of having a first heart attack
or stroke over the next 10 years. We have provided patient education tools
to our participating practices that will help them in their efforts to
reduce the cardiovascular risk of this population. From a population health
standpoint, this should translate into a significant reduction in the
number of strokes and heart attacks in our community.
6. Contracting Efforts – Aetna, Anthem EPHC
We were excited to reach a finalized agreement with Anthem for an incentive
program involving our PCP’s with a guaranteed PMPM payment including
37,000 covered lives. We also signed a new single signature payor contract
with Aetna. Not only did this result in the first Aetna rate increase
in more than 10 years, it included escalators for the rates in years 2 and 3.
7. Performance Distribution
We distributed by far the largest performance distribution to our Alliance
physicians this year. While the specialists all received the same distribution,
our separate PCP distribution was structured to increase payments to those
providers based on the number of Alliance patients attributed to them.
We plan to continue to tie distributions to performance and reward the
physicians doing the work of the Alliance.
8. Commercial Collaborative Care Coordination (4C) and MSSP Embedded Program
The 4C program extends the collaborative care coordination program that
has been focusing on our MSSP patients to patients covered by our commercial
contracts and thus includes our pediatricians. Participants attest to
addressing our core network measures with remuneration based on attention
to one performance measure and one quality measure. Documentation requirements
are minimal. With Anthem on board, this 4C program can now include over
9. Growth of the Alliance - Covered Lives greater than 70K
The Alliance has seen impressive growth in just four years. Our estimated
number of covered lives is over 70,000 through our MSSP, Aetna TCQ, Cigna
CAC, Humana, Optima, VHN, Innovation Health, and Anthem programs. In addition,
there are approximately 6,500 episodes of care we are responsible for
annually in our BPCI and QuE programs.
Network communication continues to be an area of importance to the success
of our initiatives and programs. Multiple avenues were utilized this year
to provide educational opportunities, contracting information, performance
metrics and notification of Alliance events. The Alliance partnered with
Scorpion, a digital healthcare marketing expert, to redesign our website
and set us apart by providing a more dynamic and interactive site. New
additions include a welcome page for new providers and a provider portal
including educational resources. Visit our site at
http://www.mwhealthalliance.com/. If you need a username and password, contact Pam Johns at (540) 741-2118