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 50,000 lives.

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.

10. Communication

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 or pamela.johns@mwhc.com..