Medicare Program

The Alliance “Embedded” Care Coordination Program (ECC) for Medicare patients has been in place and operating well for several years, although the program was fairly labor intensive for all involved. The Alliance Board of Managers recently approved revisions to this program, which coincides with the start of our participation in the Next Generation ACO (NGACO) Program.

The revised program now has 3 main activities:

• annual patient care visits for all attributed patients - not just AWV’s
• early follow up visits (within 3 business days) for High Risk/Rising Risk hospitalized patients
• closure of “gaps in care” for High Risk/Risking Risk patients

There will no longer be a requirement for extensive documentation by the practice and compliance will be measured through claims analysis. In addition, the NGACO patient attribution will remain constant for the entire year, without the “churn” experienced through quarterly additions/deletions from CMS during the current program. For two of the measures, payment will also now be based on a tiered compliance schedule that reflects continual progress towards an annual goal rather than a focus on activity completed during independent quarters of the year.

Commercial Program

The Commercial Collaborative Care Coordination program at Mary Washington Health Alliance was implemented in April 2017, with payment based on the level of practice attribution from Aetna, Innovation Health and Cigna patients. In the Fall of 2017, we added a large number of attributed Anthem patients to this program, which in turn raised the level of payments considerably. Recently, the Alliance Board of Managers also approved updates to this program, which are aimed at strengthening a practice’s ability to complete targeted interventions in four key areas:

• high risk patient outreach
• inpatient admissions/readmissions reductions
• appropriate emergency department utilization
• closing “gaps” in care.

An Alliance nurse will collaborate with each practice to create a specific action based on the greatest area of opportunity identified in reports from the payers each quarter. A practice must meet with their designated RN Care Coordinator at least two times each quarter to gauge progress towards achieving goals and revise the plan as necessary.

We hope that these updates will make both Care Coordination programs more effective and efficient, and strengthen our ability to meet our targeted objectives.