A high-risk patient roster, a retooled geriatric care model and a preferred SNF network are just a few Atrius Health innovations on the healthcare frontier.
Atrius Health is one of 32 participants in the CMS Pioneer ACO program testing alternative payment and program design models for accountable care organizations. Emily Brower, Atrius Health executive director of accountable care programs, shared first-year lessons during a recent webinar, Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim.
Atrius was drawn to the three-year Pioneer ACO program for a number of reasons. First, it offered the non-profit alliance of six independent medical groups a chance to showcase its core competencies, including its rich data environment, foundation in the patient-centered medical home (PCMH) model and new home care services, Ms. Brower said.
Also, it gave the Massachusetts organization a chance to build a population-based approach to managing its Medicare population as a whole, with Triple Aim goals as a foundation.
And finally, they had a lot of faith in the staff of the CMS Center for Medicare/Medicaid Innovation, where the project resides. "We feel they really understand the issues we face in being accountable for care across the continuum," noted Ms. Brower.
The Pioneer ACO shared savings and loss model challenges participants to perform against nationally identified trends. CMS take a participating ACO's population and creates from the national Medicare database a reference population, she explained. "We’re trying to beat the trend in that national population, or 'beat the benchmark.'"
In 2012, Atrius launched six clinical and technical initiatives to address the program's 33 quality measures — "the gate through which the ACO achieves savings." Key among them is its eight-step high-risk patient roster review, a hallmark of Atrius's redesigned geriatric care model.
"We used a new risk stratification tool to identify our high-risk patients, who go on a roster reviewed by a multidisciplinary team in the primary care practice to identify care gaps, including a need for advance directives." One outcome of the roster's use has been an increase in end-of-life conversations, she says.
On the technical support side, Atrius Health developed new tools within its EPIC® electronic health record (EHR) for tracking quality efforts, advanced care planning, medication reconciliation and other key metrics.
Ms. Brower estimates the total investment to launch the ACO, including the EHR, quality measurement tools and other efforts, to be between $2 and $3 million; the medical groups themselves likely spent that much again for additional care management resources.
"In terms of payback, we expect that we will be able to reduce the cost of care — to bend the cost curve so that we are beating the benchmark and creating savings that then support our additional investments."
Among programs on the drawing board: new ways to use the geriatric well visit, a home-based primary care program for high-risk patients, two programs for dual eligibles, and a patient advisory group.
Atrius Health is committed to the Pioneer ACO program, despite concerns from some participants over the program's quality measurement process communicated to CMS last month. "We know it’s going to take time. As we would say, ‘We’re not called pioneers for nothing.’ It took us that first year to identify develop most of the tools and infrastructure that CMS needed."
She continues: "The new measures that I mentioned that are coming out of the EHR being reported directly to CMS — that piece that we had to put together. There just wasn’t an existing pool of data to build benchmarks for those measures. Now that we have data, CMS will use this to create empirical benchmarks, which was one of the recommendations in that Pioneers communication."