CENTRAL OREGON ACCOUNTABLE CARE ORGANIZATION

We are excited to announce that in January the Central Oregon ACO was officially launched! The ACO is currently responsible for 11,500 traditional Medicare patients in our region (although we expect that number to grow). The ACO will run on a three-year contract with CMS and, if successful, will continue indefinitely. COIPA wanted to answer some frequently asked questions about the ACO so that our entire membership can better understand this initiative. 

FAQs

Why an ACO?

The core reason COIPA was interested in starting the ACO is simply to improve care and reduce costs for patients enrolled in traditional fee-for-service Medicare. Although we believe that all COIPA clinics are doing a great job managing this population, the high degree of patient choice allowed by CMS, geographical fluidity, and lack of comprehensive data make it difficult to take a systematic population health approach to caring for these patients. With the ACO, participating clinics will receive three years of claims data for attributed patients from CMS, including specialty services or care received in other parts of the country. This will give us a complete picture of historical utilization and cost patterns, allowing us to identify areas of opportunity for cost. They will also receive monthly updates to this claims data going forward, allowing us to track the quality of care metrics and clinics to proactively manage and coordinate care for their ACO patients.

 

Who is participating in 2018? 

In 2017, COIPA reached out to the clinics in Central Oregon who had a large share of the Medicare population, solid performance on Medicare Advantage quality metrics (as a proxy for MIPS), and/or strong engagement with the COIPA team. We are delighted that six clinics agreed to sign on to the ACO:

  • Mosaic Medical

  • Madras Medical Group

  • La Pine Community Health

  • Cascade Internal Medicine

  • Fall Creek Internal Medicine

  • Oregon Family Medicine

COIPA also reached out to St. Charles to join us as an equal partner in the ACO initiative, as a strong relationship with the hospital, sharing both risks and opportunities, is vital to address costs and care coordination for what is often a complex population. 

 

Who is Caravan Health and what is their role in the ACO? 

You may have heard the name Caravan Health mentioned in conjunction with the ACO. COIPA researched several companies who work to support ACOs and settled on Caravan as the one most likely to help ensure our success. Caravan now has almost 40 ACOs nationwide, and their preventive care-driven approach focused on leveraging Annual Wellness Visits and Chronic Care Management to close quality metric gaps and increase sustainable billing revenue, has been proven to result in high MIPS scores and shared savings for their clients. Among other things, Caravan will be guiding our participation in clinics in workflow development and billing strategies, as well as providing data support to clinics and to COIPA. 

 

What are the benefits to participating clinics? 

  • Access to CMS claims data for attributed patients and to Lightbeam Solutions population health software (primary care clinics). 

    • Three years retrospective, and monthly updates thereafter. Clinics can see the whole picture of services their Medicare patients receive and use it to improve care. COIPA and Caravan provide analytic support.

  • Reduce MIPS reporting burden (primary care and specialists). 

    • Caravan and COIPA will leverage the ACO's population health data platform, Lightbeam, to take on most of the MIPS reporting efforts. 

  • Improved MIPS scores (primary and specialists).

    • PCPs generate a MIPS score that is shared by the entire ACO; specialists report only Advancing Care Information. Caravan has developed a proven method focused on Annual Wellness Visits and Chronic Care Management for maximizing quality scores - in 2017, Caravan ACO's averaged over 90% in the MIPS quality component. Additionally, ACO scores are improved because they need only report on a small subset of their attributed patients, and have 6 weeks to validate data. 

    • ACOs receive an automatic 100% in the Clinical Practice Improvement component. 

    • Cost-component exemption - advantageous MIPS scoring, unique to ACOs. Because ACO shared savings is intended to incentivize efficient care delivery, ACOs are exempt from the MIPS cost component. The weight of the cost component (30% in 2019) is redistributed to the other components. Why is this important? By CMS' admission, cost data is not reliable due to attribution issues and high variability - most practices will be defaulted to average, amounting to a 50% score on the MIPS Cost component. This will make it impossible to score in the top 10% required to access the $500 million "exception performers bonus," that bonus will go entirely to clinics in MIPS-ACOs. 

    • Opportunity for significant shared savings to come to participant clinics (primary care clinics).  

 

Can other clinics join for 2019 and beyond?  

Short answer, yes, we do hope to grow the ACO! Ideally, the ACO could encompass all care that any Medicare patients receive in the region. More information concerning joining the ACO:

  • Primary Care: Because COIPA pays a PMPM fee to Caravan for each attributed ACO life and for data integration with Lightbeam, our limited budget means it is difficult to add new primary care clinics unless they are motivated enough to pay these fees on their own behalf. However, we do hope to grow beyond Caravan once we have established our ACO and our quality and cost strategies have been implemented and proven effective. 

  • Specialists: Because specialists face unique difficulties when it comes to succeeding under MIPS, there is a strong argument for joining the ACO to enjoy the MIPS-related benefits described above. Several clinics have already contacted us about joining the ACO for 2019, and we are very interested in exploring this option to help support our member clinics. Although we are still working out the details, there will be two main criteria: 

  1. Clinics will be asked to buy into the ACO, with a fee based on a small percentage of average Medicare billing for their sub-specialty. This fee represents a small part of the increases you can expect via your improved MIPS score, as well as savings from reduced reporting burden (EMR dashboards, IT support, etc). This will offset some of the costs to COIPA, allowing us to increase support for ACO activities and grow the ACO to new primary care clinics. 

  2. Clinics will need to work with Ashley Zeigler and COIPA's Informaticist, James McCormack, to assess their Advancing Care Information performance and capacity. ACI is the one component of MIPS that specialists participating in the ACO will need to report, and COIPA must verify that your score will not jeopardize the overall ACO MIPS score generated by the PCPs' efforts. 

 

COIPA is extremely excited about this initiative, and the potential to improve care for our patients, reduce costs, and help our clinics succeed financially in the evolving healthcare space. 

 

Please contact COIPA with any questions or to learn more about the Central Oregon ACO. 

Email: info@coipa.org

Phone: 541.585.2590

Fax:     541.585.2591

Central Oregon Independent

Practice Association (COIPA)

1230 NE 3rd St. Suite A-200

Bend Oregon

97701

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