Pioneer ACO to Specialists: If the Care Coordination Role Fits, Wear It

Tuesday, September 24th, 2013
This post was written by Patricia Donovan

Monarch HealthCare took top honors in quality performance in year one of the CMS Pioneer ACO program.


As far as Medicare beneficiaries are concerned, it’s time for healthcare to acknowledge specialists as principal caregivers of the chronically ill, advises Monarch HealthCare, a top-performing CMS Pioneer ACO.

Monarch came to this realization in year one of participation in CMS’s Pioneer ACO program, when it discovered that 70 to 80 percent of office visits by its 14,000 accountable care organization (ACO) patients were to specialists.

“We have to start treating [specialists] like a primary care provider (PCP), especially for those patients that are chronically ill, where it is actually appropriate that a cardiologist is the primary care giver for a patient with CHF and coronary artery disease (CAD),” said Colin LeClair, Monarch HealthCare’s executive director of ACO.

Engaging and incentivizing specialists in its ACO are two key facets of Monarch’s year three performance strategy, noted LeClair during a recent webinar on Medicare Pioneer ACO Year One: Lessons from a Top-Performer. Going forward, Monarch plans to tap patient data from specialist encounters to enhance its care management and quality improvement efforts.

Despite its regret at not engaging specialists earlier, Monarch’s Pioneer ACO has plenty to be pleased about at the outset of year two, in which the number of ACO-attributed patients has swelled to 22,000 patients.

In terms of quality performance, Monarch, the largest IPA in Orange County, Calif., was year one’s top scorer in several patient-centered metrics in the Pioneer ACO program, and the second highest performer in the area of medical cost reduction — a result largely driven by reductions in hospital and skilled nursing facility (SNF) utilization and unit costs, noted LeClair.

Monarch is one of 32 originally selected CMS Pioneer ACOs. Today, 23 remain in the program.

During the 45-minute program, LeClair outlined Monarch’s six-step ACO implementation strategy, a patient-centered approach built around risk stratification, ACO team-building, and care management. Trial and error during the first year yielded some interesting findings, such as the optimal time to engage a patient, he said.

Among the four success drivers LeClair shared was a coterie of Web-based population health management tools Monarch developed for its ACO team, he said, that are supported with Web and face-to-face training.

One such tool is the annual senior health risk assessment (ASHA) reviewed by the patient and doctor during the Medicare Annual Wellness Visit. The free annual well visit provides an opportunity to identify key risk factors, perform screenings and reconcile medications.

Unfortunately, the new CMS benefit is largely unfamiliar to patients, LeClair added.

Another year one lesson learned was the value of the office staff in ACO rollout. As Monarch tweaks its ACO architecture, it is considering incentivizing the office staff as well. “Too often, incentives are focused on the physicians, and the office staff actually drives most of the work to support the ACO population,” said LeClair.

In closing, LeClair said Monarch remains committed to the ACO model, and as it looks ahead to year three, it hopes to identify mini-networks of physicians, explore episodic or bundled payments, and partner with hospitals, SNFs and ancillary vendors to reduce avoidable utilization.

Click here to listen to an interview with Colin LeClair.

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