POLICY AND PAYMENT
positive outcomes, anyway, notes Stuck. Speaking to the larger need to lower the cost of care, he says, “We have made that commitment and we know that the U.S. healthcare system requires rei- magining, and it needs disruption just like Amazon, Uber and Netflix [pro- vided] in their respective industries. The [system] is not sustainable and our
attributes among those on the lead- ing edge include being physician-led and professionally managed. “If you’re going to make wholesale changes to clinical workflow and the approach that is going on across the continuum, you certainly need clinicians as lead- ers—physician leaders and nurse lead- ers—to be the champions to drive the work that they’re doing.” Another
important element, he
notes, is evolving the primary care model “to what we call an ‘advanced
Seth Edwards
taxpayers cannot afford it. Everyone is now aware of the Congressional Budget Office announcement that the Hospital Insurance Trust Fund will be insolvent in three years. So we need to look for solutions and partners together.” Few organizations are broadly
better positioned to discuss the nec- essary elements for ACO success than Premier’s Population Health Management Collaborative (PHMC), an initiative from the Charlotte, N.C.,- based Premier, Inc. that helps hundreds of hospitals and tens of thousands of clinicians work together to align, measure and improve population health. In the MSSP for 2019, 75 per- cent of Premier’s Population Health Management Collaborative ACOs earned savings for the government. Of those, 44 percent performed well enough to qualify for shared savings payments from Medicare. Since 2012, there have been 18 ACOs
across the country that have been able to generate shared savings every single year of the program, and the PHMC works with three of them. Seth Edwards, vice president of strategy, innovation and population health at Premier, and the leader of the Premier PHMC, says common ACO success
“When we started in the program in 2018, we quickly realized the need for increased awareness, education and alignment. As we progressed within the MSSP, we have made a concerted effort to identify and partner with our more engaged providers.”
-- Jennifer Jackson
primary care’ or a ‘patient-centered medical home’ type of philosophy so that you’re actively using primary care as a way to coordinate the care for the patient to assure that they’re getting the best care at the right place at the right time, which is so critical in these models.” What’s more, Edwards offers, as
organizations are being asked to take on more and more financial risk in these models, it’s important to have programs that cover different payer segments. For example, when the MSSP first started, a lot of organiza- tions were only doing population health and accountable care in the MSSP. But now, he explains, “there are broader opportunities to do it in the Medicare Advantage space, and to have value-based arrangements with your own employees, in the Medicaid space as more states shift into man- aged Medicaid, and even direct-to- employer. The more of those types of
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relationships you have—with a focus across your payer segments on man- aging populations and implementing accountable care—you will have more consistency and alignment, and you’ll be in a better position to be successful across each of those models.”
The importance of buy-in, system- wide In 2018, the Altamonte Springs, Fla.-based AdventHealth ACO was approved by CMS to join the MSSP, and has since served some 68,000 patients through the accountable care model. A member of Premier’s PHMC, AdventHealth also has an internal Population Health Services Organization (PHSO), which has helped the system gain useful expe- rience with value-based programs via its co-branded Medicare Advantage plan. That experience helped inform its approach and implementation of the MSSP, says Jennifer Jackson, chief population health officer for AdventHealth. “We quickly leveraged care coordi-
nators to partner with providers who could arrange appropriate, lower-cost alternatives for our beneficiaries’ care. We used technology solutions to identify beneficiaries with chronic conditions and even gaps in care that we could then address,” Jackson notes. She adds that AdventHealth’s PHSO also developed physician education and provider-specific reports that focused on appropriate documentation and coding. “This overall approach has helped solidify our ability to identify opportunities for clinical interventions that will improve the population’s care,” Jackson says. As AdventHealth continues to grow
in the program—Jackson says the organization expects to move forward to the Pathways to Success track in 2022—the ACO’s leaders continue to discover and learn more ways to build and adjust their operational efficien- cies. For instance, she offers, “We have learned that success with risk-based arrangements requires the engagement and participation of providers who fundamentally understand value-based care and embrace a team approach to care—which includes an aligned net- work of specialists—and those who can
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