Pioneer ACO First Performance Year Shows No Loss for Atrius Health

Accountable Care Organization (ACO) Pioneer ACO Government & Policy Centers for Medicare and Medicaid Services

| Posted On Aug 01, 2013 | By: Atrius Health

Atrius Health is pleased to announce that we do not have a shared loss in the first performance year of the Pioneer Accountable Care Organization (ACO) Model. Our loss is small enough that it is considered within the statistical range of error.  This news differs from the Centers for Medicare & Medicaid Services’ (CMS) release two weeks ago that indicated Atrius Health was one of two Pioneer ACOs (out of the 14 that had a loss of any size) that had a shared loss in the model for 2012.  This change is due to the fact that the Pioneer ACO Model results from the first year were released before the numbers for our 12 month performance year were finalized.  The financial plan that that we selected with CMS for our first 12 month performance period ended on March 2013 and our final numbers show that our loss was .98%, not the previously reported 2.1%.

We are pleased to hear this news because the improvement shows that we have made terrific progress into 2013. We are also pleased because our benchmark was more challenging than other Pioneers in our market, since we have a history of providing coordinated care for these Medicare patients. 

The first year of the Pioneer ACO Model has been an exciting process that has engaged our clinicians and staff and brought us in closer alignment. We have already seen coordinated care improvements and a decrease in our cost trends. Furthermore, our quality scores were amongst the best nationally. 

Among the accomplishments that we will detail in future blog posts:

• Created a preferred Skilled Nursing Facilities (SNFs) network with expectations for the SNFs around quality, care delivery and care management that has led to an increase in use of preferred SNFs and reduction in SNF days for both Pioneer and Medicare Advantage members.
• Developed the workflows not only to complete the quality reporting on time and under budget to receive 100% credit for reporting, but also to sustain continued improvements in quality. For example, we developed and implemented a new Epic “patient checklist” to improve capture of measures which are most clinically important for both ACO and Tufts Medicare Preferred (TMP) patients. These tools were placed in Epic mid-February ’13 and by mid-April more than a quarter of our ACO & TMP patients had already had a falls risk assessment and a depression screen required by end of year. 
• Built a model to identify high risk patients and then highlighted those patients at highest risk of hospitalization, poor health outcomes and high costs.
• Adopted shared standards across our practices for high risk roster reviews and locally implemented new care management roles.  For those of our medical groups who have most fully implemented high risk roster reviews, early data shows that hospital admits and ER visits per thousand declined by several percentage points since the beginning of the year
• Integrated new Atrius Health affiliate VNA Care Network & Hospice into ACO activities, including new standard work for referral and communication, and communicating their preferred status to our SNF network.  We see that in 2012 the percent of VNA episodes going to VNA Care Network & Hospice has increased significantly with an associated decrease in claims expense for home health care.
• Developed an advance care planning (ACP) curriculum to improve primary care physician (PCP) knowledge and comfort with advance care planning, increase end-of-life conversations and collect patient’s care wishes.  This is in continued stage of roll-out as planned.

We will harvest these results as we move forward on our Pioneer ACO Model journey to provide better care, better health and lower costs for our patients.

For more information, contact Marci Sindell, Chief External Affairs Officer at marci_sindell@atriushealth.org or 617-559-8323.