One step John C. Lincoln network took to improve performance results at the end of its first year as a Medicare Shared Savings Program accountable care organization (MSSP ACO) was to focus on a relatively small number of patients, the top 5 percent of beneficiaries by claims volume who actually account for about 60 percent of medical spend, explains Heather Jelonek, CEO for ACOs at John C. Lincoln Network, who shares additional strategies here.
First, we decided to institute wellness visits across our health system. We’ve worked with several large third party payors here in the valley where they’re now recognizing the Medicare G-codes for wellness visits. We bring those patients in and get a full survey of what’s been going on with them.
Second, we’re engaging in regular population management. We now have our physicians talking about how often they want to see their patients with diabetes or hypertension or cancer.
Third, we're also starting to focus on those individuals who are ‘aging in;’ those patients who are about 62½. We’re trying to get them in and get them into a routine, making sure they’ve got A1C scores every quarter and every six months, and have had their flu shots and colonoscopies. We’re hoping a healthier generation of individuals coming into the Medicare program improves the quality outcomes that we’ll see long-term.
Fourth, we've developed a standardization for our quality reporting. We’ve looked at the top 5 percent of our beneficiaries by claims volume, who actually account for about 60 percent of our medical spend. We’re hoping that by focusing on a relatively small number of patients, we’ll have a drastic impact on outcomes.
Next, we're also leveraging our electronic medical record (EMR) to the fullest extent; we’re participating in a number of conversations and baseline studies with EPIC®. They are very interested in seeing what we’ve done with the tool and how we’re making it usable for our ACO reporting.
But the one thing that we will continue to struggle with and continue to dive deeply into is integration opportunities: talking to other communities, looking at health information exchanges (HIE’s) as we’re acquiring a new practice or signing a new community physician onto our ACO bringing everybody to the table so that we’re all speaking the same language.
Excerpted from Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care.