ACO leaders describe patient care improvement plans

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Health systems are finding ways to improve patient care through transitions to risk-based contracts.

Three health system leaders shared their insights in “Embracing Risk and Achieving Success through Multi-Payer Alignment,” a Sept. 21, 2023, presentation during the fall 2023 conference of the National Association of ACOs.

The goal is “to optimize patient care and enhance reimbursement opportunities across all value-based contracts,” including the Medicare Shared Savings Program, Medicare Advantage, and commercial payers, said moderator Tim Gronniger, senior vice president of development and strategy for Signify Health.

‘All about prevention’

Crouse Health Network operates a private, nonprofit hospital with 506 beds and 57 bassinets serving a 15-county area in central and northern New York. It has a multispecialty practice with 15 specialties and 220 providers, and is the largest primary care network in its region, said Christina Pavetto, director of population health.

The network’s value-based care strategy includes:

• Participate in revenue-sharing arrangements to facilitate reimbursement for preventive, coordinated, efficient care.
• Develop an infrastructure to support value-based arrangements across payers.
• Offer support for providers to focus on excellent patient care.

“Our model is rooted in primary care, so it's all about prevention and enabling patients to self-manage and to advocate as an active part of the team member,” Pavetto said. “So it's not based in solely trying to prevent readmissions for example. In that case, as we look at it, the horse is already out of the barn, they they've had a hospitalization. So we focus our efforts and support of primary care and make sure patients are truly, you know, educated and knowledgeable about the kind of care they want to receive and should be receiving by their definition.”

Share the best

Ardent Health Services is based in Nashville, Tennessee, and has 30 hospitals and more than 200 sites of care with 1,400 aligned providers in six states, said Eloy Sena, AVP, value-based contracts and operations.

Its value-based care strategy “centers on optimizing resources, streamlining processes, and leveraging innovative technologies to enhance care delivery while minimizing waste and redundancy.”

The company aims to identify its “Best in Ardent” practices and deploy those to other markets. Those include resource sharing, value analytics, schedule optimization and prioritization, electronic health record optimization, and enterprise rollout of services such as chronic care management and remote patient monitoring.

Then, the leaders identify gaps that affect the company as a whole and find ways to bridge those through strategic use of resources, Sena said.

“Our value-based care strategy from an art in perspective is really a journey,” Sena said. “And part of that journey is learning how to function and do value-based care at a corporate level and support our individual markets, while still allowing those markets to operate independently.”

‘Levers of Success’

MultiCare Connected Care was established in 2014 as an independent business entity by MultiCare Health System. It has established a comprehensive clinically integrated network (CIN) comprised of doctors, hospitals, clinics, and other health care services such as imaging, labs, and pharmacies, said Sam Johnmeyer, director, actuarial services and medical economics.

MultiCare serves about 400,000 value-based lives, with 46% “high risk” and a 60/40 commercial/Medicare split among the high risk.

MultiCare devised a framework called “Levers of Success,” a grid with with levers, descriptions, key initiatives, yearly values, and color-coded progress.

For example, the lever care management has the description patient/beneficiary level initiatives, and key initiatives such as transitional care management, chronic care management, remote patient monitoring, and newly diagnosed outreach. The other levers are utilization management, risk adjustment, retention, and quality.

“If you're new to value-based care, this is a good way to like present it in an easy to digest format and it's like, OK, I kind of know what I need to do. We're doing this, we're not doing this, so maybe we should think about this, Johnmeyer said.