January 9, 2019

Hello MaineHealth ACO Participants,
With a new year comes clarity of thought, focus on solutions, and hope for the future. With this winter letter, I am going to do just that: share clarity of why we do what we do, a focus on solutions, and hope for a meaningful 2019. And I am going to cut to the chase without metaphor or simile this time.

Today, I am sharing with you three key components of our crisp winter vision: the 'why' of the ACO, our priorities, and our understanding of the changes to the Medicare Shared Savings Program (MSSP) which is now called Pathways to Success.

It's easy to get lost in the intricacies of the ACO's work. Every year, we analyze and report on tens of thousands of data points that describe our progress managing quality and utilization. We negotiate more than 16 complex contracts with payers. We staff collaborative initiatives to lower ED utilization rates and readmissions. We help to manage the care of hundreds of complex patients. We provide practices with hands-on improvement assistance. It's all good work. But why are we doing it? Ultimately, the MaineHealth ACO and its network of 1,600 providers are working to improve patient's care, their health & well-being, and their experience in accessing care in the right place at the right time. That's what it's all about. Better patient care in a healthcare environment where providers are supported, resources are accessible, costs are lower. Our data measure progress toward better patient care. The contracts we negotiate are structured to reward better patient care. The clinical initiatives we staff have better patient care as their ultimate end. Our practice improvement support gives practices the tools to achieve better patient care. And personally, every strategic initiative I support, every meeting I attend, every presentation I give and every decision I make as the president and CEO of the MaineHealth ACO has better patient care as its ultimate goal.

ACO Priorities

Thanks to the clarifying vision of our Board of Directors, the Value Oversight Committee (VOC) and the Physician Engagement & Alignment Committee (PEAC), we've developed three concise priorities that will drive the ACO through 2020:

Let's take a closer look.

Priority 1: Achieve the Quality Top 10 - Continuing our network's success improving quality outcomes, we will maintain our support of practices achieving the latest goals set for the ten highest-impact quality measures. We don't anticipate any major changes to these measures over the next year. Our focus will continue to be on preventive screenings and chronic condition outcomes.

Priority 2: Manage Utilization and Cost - Managing the cost and utilization of health care is a new area of expertise we all have to master together. In response, the ACO has created multi-disciplinary teams to address two major drivers of low-value utilization over the next two years: preventable emergency department visits and avoidable admissions/readmissions. With input from the Value Oversight Committee and in collaboration with ACO participants, these teams are creating evidence-based interventions that hold significant promise for real, measurable impact. Our population health management tool Arcadia will guide us with data and analytics to help you to understand your areas of opportunity and to be successful in managing utilization.

Priority 3: Accurately Represent the Health of Patients - As we participate in more value-based agreements such as Medicare Advantage plans that ask you to manage care with upside and downside risk, precise and accurate documentation of diagnoses becomes increasingly important. More precise and accurate documentation can increase the likelihood that health plans offer and reimburse condition-specific services and benefits. For all providers in the ACO, more precise and accurate documentation can lead to more reasonable quality and utilization goals and the savings generated can be rolled back into providing better patient care.

The "new" Medicare Shared Savings Program: "Pathways to Success"

As you may recall, we are in our last year of Track 1, the upside-only Medicare Shared Savings Program (MSSP) track that the MaineHealth ACO has participated in since 2012. We made a decision last April to move to the downside risk program called Track 1+. However, in August 2018, CMS announced plans to overhaul the entire MSSP program and proposed a new rule that was under review through the fall. On December 21 st, CMS announced the final rule governing MSSP calling the new program Pathways to Success. It will have two tracks: Basic and Enhanced.

Here's what we know:
  • Our current upside-risk-only MSSP agreement will be extended through June 30, 2019.
  • New program starts July 1, 2019.
  • Streamlined participation tracks will move ACOs to higher levels of risk more quickly.
  • The program commitment changes from 3-year to 5-year agreement periods.
  • The current multiple MSSP tracks (e.g.: Track 1, 2, 3) will be retired and will now be:
    • Basic Track with five level options (Levels A-E)
      • Basic track levels A and B are upside only
      • Basic tracks C - E have graduated risk
      • Basic Track E is equivalent to the former Track 1+
  • Basic Level E Track and Enhanced Track are the only tracks that qualify as an Advanced APM for MACRA. These tracks provide ACOs with additional tools and flexibilities in exchange for taking on higher levels of downside risk.
  • Enhanced track is equivalent to the former MSSP Track 3 model.
  • A potential path for us will be one that closely resembles our initial plan to move to Track 1+, meaning a gradual assumption of downside risk.
The ACO is currently reviewing the final rule in detail and analyzing the most appropriate participation model for the ACO that we will take to the ACO Board and Owners for final decision making. Look for a future Hello from Betsy email announcing our conclusions.

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While these details are complex, there is clarity in our goal: achieving better patient care. 2019 will find us with clarity of thought, focus on solutions, and hope for the future. Through Pathways to Success we will find our success together. I wish all of you a hopeful New Year and look forward to partnering with you throughout the months ahead.
Yours in health,
Elizabeth H. Johnson, MD, MS, FACP
President & Chief Executive Officer
MaineHealth Accountable Care Organization
EHJohnson@mmc.org | (207) 482-7050