Nearly $15.4 million in Medicare savings and just under $8 million in bonus
That stunning picture was not a common achievement for accountable care
organizations in 2018 – and certainly not for a first-year ACO, especially with quality reporting requirements that accompany the healthcare industry’s seemingly seismic shift from fee-for-service to value-based care payment models. But $16 million in savings and $8 million in extra payments from the Centers for Medicare and Medicaid Services (CMS) is exactly what happened for Affirmant Health Partners and its brand-new Federation ACO, which had a 100 percent quality score.
Only one-third of the country’s ACOs earned cash back as a result of quality
reporting in 2018.
“For first year ACOs, it’s even a tougher challenge,” said Affirmant Health Partners’ executive Lawrence S. Green, A.M., MBA, director of payer strategy and ACO operations. “We were one of the few ACOs that made money the first year.”
How did it happen? First, it’s important to understand Affirmant’s leadership DNA where “collaboration” is a frequently-used term, but not because it’s a trendy buzzword. Collaboration is a vital part of Affirmant’s structure. Another equally significant component of the Super Clinically Integrated Network’s core is proactive leadership.
So when Kalamazoo, Mich.-based Affirmant launched the Federation ACO in 2017 – now some 5,000 physicians strong with 74,000 attributed lives - there was no question that the leadership team needed a partner with quality reporting expertise and a sterling resume to back it up. As Green and his team surveyed the quality reporting landscape, Primaris Healthcare Business Solutions continued to appear, partly as a result of Primaris’s work with institutions that Green had connections to: Emory, University of Chicago (where Green went to graduate school), and Northwestern (where Green is completing his PhD).
“Since I had history there, I knew what the robust nature of those organizations would entail,” Green said. “And if you had positive feedback from those organizations, then you had to be at the top of your game.”
Green also pointed out that Primaris had a strong reputation for quality reporting abstraction and quality improvement from the company’s previous work with the Group Practice Reporting Option (GPRO) in Michigan. (GPRO morphed into CWI.)
THERE ARE NOT MANY COMPANIES THAT DO HAVE THE HORSEPOWER AND, MORE IMPORTANTLY, THE EXPERTISE TO DO THE THINGS THAT PRIMARIS DOES.
When the Federation ACO formed, the team simply did not have the capacity or skill to take on CMS Web Interface Reporting (CWI) to meet Quality Payment Program (QPP) and Merit-based Incentive Payment System (MIPS) requirements.
"We did not have the horsepower to do that,” Green said, describing the decision to partner with Primaris for CWI reporting work. “Quite frankly, I would dare say there are not many companies that do have the horsepower and, more importantly, the expertise to do the things that Primaris does.”
The money saving and cash-earning results for 2018 were based on the 2017 reporting year. Green expects another round of “fantastic results” for next year, too.
The Federation ACO is owned and managed by Affirmant Health Partners—a clinically integrated network. Affirmant is a physician-led organization focused on collaborating with patients, colleagues and community partners to improve the quality and cost-effectiveness of health care. Six leading health systems and their affiliated physicians make Affirmant one of the largest super clinically integrated networks in the state of Michigan. These leading health systems are: Bronson Healthcare (Kalamazoo), Covenant HealthCare (Saginaw), Henry Ford Health System (Detroit and Jackson), Spectrum Health Lakeland (St. Joseph), MidMichigan Health (Midland) and Sparrow Health System (Lansing). The Federation ACO is comprised of Bronson Healthcare, Covenant HealthCare, Henry Ford Allegiance Health,
Spectrum Health Lakeland and Sparrow Health. MidMichigan Health participates in the Physician Organization of Michigan (POM) ACO and Henry Ford Health System has its own NextGeneration ACO.
According to Crane’s Detroit Business, The Federation ACO was one of only two ACOs in Michigan to earn shared savings while achieving a 100 percent quality score. The other was Trillium Health, which earned $1.9 million in savings. The scope of the Federation’s size makes the savings and earnings picture even clearer. About 30 percent of the ACO’s physicians are primary care doctors – family practice, pediatricians, and other traditional PCP practices – and the ACO’s patients represent 25 percent of the state’s hospital admissions.
“This is a remarkable story,” said Primaris CEO Richard A. Royer. “You have a fairly new ACO – one of the largest in the country comprised of six well-established health systems – that successfully overcame inter-competitiveness and the challenges of having disparate health IT platforms.” As a result, the ACO and its member worked with Primaris to get deep into the CWI abstraction and reporting process, having complex conversations and achieving significant, measurable improvement in just two CWI reporting seasons.
FROM LEADERSHIP TO FRONT-LINE QUALITY STAFF, COLLABORATION WAS KEY TO THE SUCCESS.
“We had an amazing experience with them this CWI season. There were a number of improvements made this year,” Royer said.
As with any productive, meaningful partnership, the process was also beneficial for Primaris by further customizing its chart abstraction and quality reporting approach; with daily meetings and the ACO following up on 100 percent of fails; and a random amount of passes, to ensure the results were accurately reflected in Primaris’s trademarked data abstraction reporting tool, or DART.
Primaris’s inter-rater reliability for the 2018 CWI reporting season was above 95 percent. The company’s overall 2018 IRR average was just under 98 percent.
“From leadership to front-line quality staff, the collaboration was key to the success. We learned a lot from each other,” Royer added.
Initially, the Primaris CWI reporting team had a weekly call with the entire
Federation team, but that was changed to weekly calls with each chapter.
“There are unique challenges at each organization,” Green said. That meant a one-hour call each week for 12 weeks with representatives of each chapter. “That proved to be extremely beneficial,” he said.
Primaris was “very instructive” about the quality reporting landscape, Green added. The proprietary DART tool was especially helpful and chapters now use it almost daily. The Primaris team leaders are receptive to feedback and “hands-on and really instrumental in our success,” he said. “We’ve been blessed to have a great team from Primaris.”
The expertise solidified Affirmant’s confidence in the chart abstraction process that resulted in a 100 percent quality score for the Federation ACO. Green said there was no concern about the data being accurate, reliable, timely, and actionable. (A four-part feature that Primaris has dubbed ARTA.)
“We never thought that we would have any challenge with that. And we never did,” he said.
WE’VE BEEN BLESSED TO HAVE A GREAT TEAM FROM PRIMARIS.
In the Affirmant Health Partners’ 2018 Value Report, Affirmant President and CEO, Dr. Bill Mayer summed up a series of successes – including quality reporting and cost savings.
“In the time since our formation in July 2015, the trends propelling our
collaboration have only accelerated. The Medicare Shared Savings Program as we know it is ending, with ACOs having no alternative but to accept both up- and down-side risk. Affirmant gives us the opportunity to collaborate in taking charge of our destiny, to make better decisions with our patients, bend the health care cost curve and share in the rewards, and improve the health of our patients and communities.”
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