Growing up in the South, I learned early on that the only football league to cheer on was the SEC (Southeastern Conference). So, it was amusing to me that on New Year's Eve I found myself at the Patriots game in 10 degree weather, bundled in a plush Patriots blanket, quaffing hot chocolate and madly cheering on the hometown team. I knew then that I had become part of Patriots Nation. Sharing in the wild enthusiasm of the screaming crowd, ignoring my frozen toes, and reveling in the moment of the Patriots' win with our two sons was well worth the evolution from SEC college football enthusiast to hardy New England Patriots fan. Change is inevitable. And becoming part of new traditions and customs is part of our journey in life. My grandfather, who was an official for the SEC, would understand, I'm sure. (And yes, I have been following with interest as Georgia moves through the National Football Championship games.)
all find ourselves immersed in the changing "traditions and customs" of healthcare. These changes are hitting particularly close to home here at the ACO as we contemplate a major crossroads for the organization. You may be aware that we're entering the final year of a three-year agreement with the Centers for Medicare and Medicaid Services (CMS) to provide care through the Medicare Shared Savings Program (MSSP). We're in "Track 1" of MSSP, which rewards us for cost savings without penalizing us for cost overruns, known as an upside risk agreement. This is our second Track 1 agreement with CMS, and we're barred from entering into a third. We have until May of this year to tell CMS how we want to move forward. Before then, the MaineHealth ACO needs to consider the following three options:
- Entire ACO network: Apply to move the entire network (all current ACO participants) to a downside track with financial risk for everyone
- Bifurcate ACO Network: Move a sub set of our current Track 1 Participants into a downside track (Advanced Alternative Payment Model) which would limit risk and allow downside risk ready participants to dive in
- Options for the remaining MaineHealth ACO participants could be:
- We form a new Medicare ACO (that's part of our larger ACO) that can then apply to MSSP Track 1 (MIPS/APM)
- Or leave the MSSP program and be MIPS-only practices
3. Depart MSSP program: All ACO participants exit the MSSP program entirely
The MaineHealth ACO Owners include all of the MaineHealth member CEOs (Tim Churchill, Jim Donovan, Mark Fourre, MD, Ed McGeachey, Scott McKinnon, and Rich Petersen), MaineHealth Corporate CEO (Bill Caron) and Specialty Solutions CEO (David Landry), and they have been considering these options since last fall. They will take a vote by April 2018 so we can inform CMS of our decision by July 2018.
To remind you, we have been part of the CMS Medicare Shared Savings Program (MSSP) since its inception in 2012, and we now care for up to nearly 55, 000 Medicare beneficiaries. Our 1500+ ACO providers continue to provide the highest quality care with compassion and concern. Your superior care is reflected in the excellent quality results our ACO achieves. Together, we have navigated the nuances of achieving quality metrics, learned what it means to "beat the benchmark", honed skills on delivering population health, braved sharing our performance on public "heat" maps and embraced a requisite understanding of the need to manage the costs and utilization of the care we deliver. As we have prepared for taking on downside risk payment models, we have built robust care management teams to coordinate and enhance the care experience of our patients, have instituted process improvement methods and tools into our daily routines, implemented data technologies to analyze and understand our performance, worked to reduce variations in care, and planned for system-wide service line development. The pressures and demands of this work can be unrelenting, but at the same time the professional satisfaction for improving the health and well-being of an individual patient is irreplaceable.
The decision that we make with Medicare and its MSSP programs will guide us into the next chapter of our journey. I don't foresee becoming a Big Ten fan any time soon but know that change will always be part of where we next go to bravely transform, improve, and "fix" our health system. I hope that you as ACO participants feel informed about the Medicare decision that lies ahead and welcome hearing from you regarding questions, concerns or ideas. The topic is complex, and for those of you who would be interested in more reading on Medicare Risk, this Advisory Board summary document is excellent. While long, it has great summary pages and references.
Finally, after cheering my way through that frigid New Year's Eve game, I feel that I have earned the privilege to offer a very warm wish to all of you for a happy, healthy, and prosperous New Year.