April 25, 2018

Hello MaineHealth ACO Participants,
Last summer, while dancing at my niece's wedding, I twirled and ruptured the posterior root of my medial meniscus.  After a month or two of conservative management, surgery was recommended.  At my first visit, Linc Avery, my orthopedic surgeon, sighed and looked at me kindly and said, "you have a complex knee problem...it's not only an alignment issue but also one of weight on the knee. I can fix it, rehab will be intense, and you will have your part to play, too. Knees don't like misalignment and they don't like extra weight."  
Wait, wait, wait, I thought.  What did I just hear?  After weeks of agonizing knee pain, hobbling around, and then a frank "blow out" of my knee, I was now facing surgery, weeks of physical therapy, and what else?....Fix the weight issue?
Well there it was. My doctor telling me I had "a weight issue."  It of course made me mad, but was a great wake-up call. I had to kick into gear, change my lifestyle habits that night, and start the messy process of getting the weight off.  As a primary care doctor, I am well versed in motivational interviewing to change behavior but now it was being done to me.  And it was powerful. Through a supportive family, an expert surgeon, a responsive clinical team, and a skilled physical therapist, I am now back running around, dancing, and am healthfully lighter--committed to a lifestyle that will keep me here.
So, believe it or not, my lifestyle-changing knee problem shares something in common with the game-changing decision that the MaineHealth Board of Trustees and MaineHealth ACO Board of Directors unanimously approved last week: to proceed with the Medicare Shared Savings Program (MSSP) Track 1.5 program and accept downside risk to incent movement from a volume-based healthcare environment to one of value, better outcomes, and lower cost.  Both my recovery and this decision owe much to motivational interviewing. In the case of the MSSP decision, your motivational interviewing . . . we listened to you. As providers, you challenged the status quo and gave us simple but direct advice, "it's time to change, and we can do it."  The CFOs held, "we can tolerate this risk."  The CEOs championed, "we can lead this," while the Board of Directors voted "we can support this." We all believe we've got to do this differently, and we have to do it now:  time to surgically treat the issue, rehab the problem, and change our approach.  No more conservative management.  In this letter I am excited to announce this major decision regarding our future direction, the evolution of our provider network and our deepening commitment to value based healthcare.   
For many months, our staff, providers, leaders, board and owners have been carefully considering the opportunity to move to a downside-risk track of the Medicare Shared Savings Program (MSSP), the value-based Medicare contracting model that inspired the creation of Accountable Care Organizations (ACOs) around the country. In my last letter to you, I wrote about the choices we had. To remind you, MaineHealth ACO's history with MSSP goes back six years, when we first entered into Track 1, an upside-risk-only MSSP contract that generates shared savings when certain cost, quality and utilization targets are hit. Track 1, which the ACO continues in today, does not assess a financial penalty when those targets are missed. The new MSSP track under consideration, Track 1.5, is an advanced alternative payment model (APM) and includes downside risk. It offers the same opportunity to earn shared savings as Track 1 when targets are hit and includes a financial penalty if targets are missed. 
Thoughtful, in-depth analysis of our MSSP participants' readiness for downside risk gives us confidence that a sizable cohort is well positioned to succeed in a downside risk environment. Specifically, this cohort includes providers employed by MaineHealth and by York Hospital who are supported by robust population health, quality improvement, data analysis and administrative resources. We're pleased to announce that MaineHealth-employed providers will be shifting to MSSP Track 1.5 in January, 2019, pending Medicare approval. York Hospital providers have been invited to join Track 1.5, as well.
All other MSSP participants will have the great opportunity to continue in Track 1 by entering into a new three-year MSSP agreement in January. To comply with CMS guidelines, the ACO will establish a new subsidiary corporation to host that agreement. We anticipate that Track 1 participants will feel no practical impact from this structural change. You will receive the same benefits of participation and support from the ACO that you've come to expect over the previous six years. 
Our time is now. Together we can succeed in our mutual quest to meet the Quadruple Aim and achieve a lasting change in the course of healthcare.  As proud as I was of my response to the challenge of my knee problem, I was humbled last week when I watched and read the stories that marked the fifth anniversary of the Boston Marathon bombings.  The tenacity, bravery, and indomitable spirit that allowed the survivors to rehab for years and run new marathons, reminded me that all of us are capable of rising to the challenge of running a new course. 
I'm thrilled that we can offer an innovative MSSP contracting solution that meets all our participants where they are. Track 1 will remain available to those who continue to benefit from it. And Track 1.5 will offer new opportunities to providers, practices and hospitals for us to think and act differently. 
To learn right away about the details and implications of our MSSP decision, and ask questions of ACO leadership, please attend a session of this special informational webinar:
The ACO's Medicare Risk Decision: What it Means to You
Tues., May 1, 5 - 6 PM Register
Wed., May 2, Noon - 1 PM Register
Thu., May 3, 7 - 8 AM Register
To receive ongoing updates about the decision and tips for how to succeed in the Track 1.5 downside risk environment, please subscribe to the monthly ACO eNews.
I know we're up to the challenge and look forward to partnering with all of you on this next endeavor.  In the weeks to months ahead I will write to share suggestions on what we need to do next to succeed and, more importantly, get your input and insights on running this marathon.  Please do not hesitate to get in touch with me directly at ehjohnson@mmc.org.
Yours in health,
Elizabeth Johnson, MD, MS
President & Chief Executive Officer
MaineHealth Accountable Care Organization
EHJohnson@mmc.org |  (207) 482-7050