Medicare ACO Core Strategies

Success in an ACO means improving patient outcomes and experiences, enhancing the clinical experience and reducing costs. To achieve these goals several core strategies need to be in place. As we near the end of the year, it is time to review your ACO status on achieving core strategies such as:

HCC Recapture Rate: This percentage represents the rate at which recurring chronic conditions have been re-captured from the prior year. The goal is 85% by the end of 2021. If you have providers at 60% recapture rate or lower now, then an effort to schedule annual wellness visits needs to be started for the 4th quarter with a focus of documenting patient HCC diagnoses and putting care plans in place.

For easy workflow processes use a point of care solution that prompts the care team on a patient level to code the diagnoses not yet recoded in the current year or use a bulk report such HCC Not Recoded for all patients. As the risk score and financial benchmark are driven by the HCC recapture rate it is a critical component. For 2022, consider a provider team compensation incentive plan to reward high HCC recapture rates.

Value-Based Care Point of Care Solution: A point of care solution is necessary for providers to access actionable data at the point of care. Trending charts and excel spreadsheets are great for trending, but a point of care solution is necessary to put the strategies in the provider team workflow.

Out-of-Network Migration: Reducing out-of-network migration is important to care management processes. A patient being treated outside your value-based care network, won't be engaged in your processes and care protocols.

PAC Performance: A review of Skilled Nursing Facility (SNF) performance to determine your referral network is imperative to your ACOs success. SNFs drive high volumes of spend. To make decisions about your network you need to know average length of stay, average cost per day, rate of complications, emergency visits, and re-admissions.

Acute Hospital Utilization (AHU): Every provider has an expected rate of hospitalizations based on their assigned patient's history, risk score and other factors. The goal is to ensure provider's do not exceed their AHU expected (benchmark) rate.

Aggregate Expenditure and Utilization: On a quarterly basis, Medicare provides each ACO with an aggregate expenditure and utilization report (QEXPU). The Medicare CCLF data can be modeled for each service area in the QEXPU such as 30-day all cause readmissions to pinpoint poor performance at an NPI, facility or other level.

Quality Payment Program: Keep your upward MIPS adjustments and start preparing now for the QPP APP APM Entity reporting option.

ACO Core Strategies Boot Camp

Join us October 1st: https://attendee.gotowebinar.com/register/5473029551738011151

Kris Gates, Health Endeavors, [email protected], 480.912.1209