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An ACO story: How calculated risk is paying off

The Centers for Medicare & Medicaid Services (CMS) began offering the voluntary Shared Savings Program to improve healthcare’s track record with outcomes, experience and cost. Accountable Care Organizations (ACOs) that demonstrate quality and savings earn rewards – the more risk they take on, the more money they can earn.

But, for various reasons, the majority of ACOs have opted for the one-sided risk arrangement (Track 1), in which there is no downside because they do not share losses. In fact, only one in five ACOs have opted for two-sided risk arrangements (Track 1+, Track 2, Track 3) that offer a larger portion of savings if successful.

Coastal Carolina Health Care’s (CCHC) ACO took the calculated risk to enter into a two-sided arrangement (Track 1+). It’s paying off; CMS has consistently ranked it among the top performers for quality nationally, and the organization took the top spot in 2016.

“I’ve enjoyed working with CMS on the ACO,” Chief Executive Officer Stephen Nuckolls said in a recent case study. “There are still issues to overcome, but it’s getting better and better. Getting paid for providing higher quality care is clearly a move in the right direction.”

Measuring success against the Triple Aim

CCHC offers a great example of how to succeed with value-based care. When evaluating its progress against the framework commonly known as the Triple Aim, its achievements are even more impressive:

1. Better health for populations

CCHC uses Allscripts TouchWorks® EHR data to improve clinical results in many ways. For example, CCHC generates lists of patients that are due for preventative care, such as mammograms and colonoscopies. Primary care providers then followed up with these patients and increased compliance with evidence-based guidelines for preventative care.

Better preventative care and population health management improves other clinical results, too. For example, CCHC reduced rates for both ER visits and hospital readmissions by 10-15% in one year.

“We used lots of programs to accomplish great clinical results,” Nuckolls said. “Allscripts TouchWorks® EHR is the main data repository and tool at the center of these efforts.”

2. Improve patient experience of care (quality and satisfaction)

As part of its commitment to improve quality, CCHC is working to actively involve patients in their own care. CCHC launched the FollowMyHealth patient engagement platform from Allscripts at the beginning of 2014. In the first six months of using the portal, about 12% of CCHC’s patients have enrolled. By 2018, well over half of CCHC’s patients were enrolled.

“FollowMyHealth helps us build relationships with patients. So now they’re more likely to bring their concerns to us, instead of just rushing to the ER,” Nuckolls said. “We’ve just started, and enrollment continues to move upward.”

3. Lower the cost of care

CCHC participates in several government incentive programs, and its participation has helped lower the overall cost of care. Per capita costs per patient is now well below community and national comparisons.

“CMS’ Quality and Resource Use Reports for 2012 showed that our per capita cost per patient was slightly above the national benchmark, but by 2016 CMS’ report showed that we were more than 20% below,” Nuckolls said. “Our regional comparison for 2016 also shows that our per capita costs are below our community average of assignable patients.”

What’s next for CCHC?

Nuckolls expressed his confidence in ACO principles to improve healthcare costs and quality. “We are currently assuming limited downside risk in track 1+ and are considering moving to a higher level of risk and reward in track 3 for 2019,” Nuckolls said.

To learn more about CCHC and its ACO journey, download this case study.

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