Episode 25 – May 2021: A Peek Inside Our New Annual Report

Julie Grosvenor: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, a minimally invasive monthly podcast for health care providers. I'm Julie Grosvenor.

Mike Clark: And I'm Mike Clark. Julie and I are practicing physicians and liaisons with the MaineHealth ACO. In this episode, Andy Russ, LincolnHealth VP of Medical Affairs, tells us how he kept the area's provider community informed and united during the pandemic.

Julie Grosvenor: But first, we talked to the ACO's chief medical officer, Rob Chamberlin, about what readers will find in our new online annual report.

Mike Clark: Yep, that's coming up right now in our Meaty Topic. So let's dig right in.

Julie Grosvenor: Every spring, the ACO releases its online annual report, which is a quick rundown of what the ACO was up to the previous year and how it performed. This year's report is particularly meaty, if I can say that, because it contains more financial quality and utilization data than we've ever seen before. We invite you to take a look by navigating over to MHACOannualreport.com. That's MHACOAnnualReport.com. And here to give us highlights from this particularly media report is Rob Chamberlin,, the ACO chief medical officer. So, Rob, why don't you start off by telling us what stands out in the 2020 report?

Rob Chamberlin: Thanks, Mike. So the communications team, led by Paul Santomenna, really did a tremendous job with this annual report. And as I looked through it, there are lots of things that I was proud of our health system for accomplishing. But I would say the things that stuck out most to me, you know, as a clinician, we kind of approach these as those things that matter most to our patients. And I think ultimately what matters most to our patients is those things which we categorize under the bucket of utilization. So we show a nice long term trend here of decreasing the number of admissions to hospitals, decreasing the number of admissions to the ED department. And at the end of the day, that's what patients really care about most. Are they getting sick or are they ending up in the ED? Are they ending up admitted to the hospital? So it was really nice to see those trends over the past few years in the right direction of decreasing that type of utilization.

Julie Grosvenor: That's great. One thing I like about the report is the straightforward financial data, we can see how much the ACO earned from the value-based care contracts and also the total amount of health care savings that the ACO generated in 2020. But that might be a new number for some of us. So can you tell us what that means?

Rob Chamberlin: Right. So the ACO total savings is how much the patients who are in our value-based contracts, what their total medical expense was compared to what the projected total medical expense was. So each of the payers project that their members will cost a certain amount of money every year. And then at the end of the year, we do what's called the reconciliation to see if the patients actually cost as much money as the actuaries said they would. And our goal is for us to bend that curve, so to speak, for our patients to cost less than they are expected to cost. And this year, we did that to the tune of about 23 million dollars.

Julie Grosvenor: Wow, 23 million dollars. That is impressive. So what happens to that money?

Rob Chamberlin: So a portion of that money gets sent back here to the MaineHealth ACO. This year, it's around six million dollars that the payers send back to us as part of our value-based contracts. And that money is then redistributed out to all of our providers based upon a standard that we call our distribution model. And so if you're a private practice PCP, you might actually get a check that you get in the mail. If you belong to MaineHealth or St. Mary's, as an employed group, the money goes to those systems and those systems take that money to invest in things like care management and other systems and programs to help invest in initiatives that will continue to deliver higher value care to our patients.

Mike Clark: Wow, that that's pretty impressive. In addition to the financial numbers, though, I found my eyes are going to the quality graphs. The report shows performance on six quality measures over the last four years and the progress was really good year over year up until the first quarter of 2020. And then we drop off a cliff into the pandemic. Can you talk a little bit about that?

Rob Chamberlin: Yeah, it's a national trend. And what you're seeing there is just when patients didn't have access to their health care, and many of these are primary care metrics, then we start to fall behind on the management of some chronic diseases and some screening, cancer screenings and some other key metrics. And so we, like everyone across the country, saw a significant decline in our quality performance in 2020. We started to see a pick up on that later in 2020. And we're hoping that this year we continue to see that positive momentum. But certainly the pandemic hit us hard there.

Julie Grosvenor: Well, I have every faith that our providers can get us back where we want to be in our quality metrics, and thanks for this quick preview here. I cannot wait to dig in to the meat of the report on my own.

Rob Chamberlin: Yeah, you're welcome. Thanks for having me on. And I would also like to just say thanks to all of our providers and the care teams out there who are really doing great work. And that's reflected in the cost savings, the quality improvement that we're seeing more recently and the overall good performance. So thanks to all of our care teams.

Mike Clark: So remember, the report is online at MHACOannualreport.com. You can also get it by going to our home page, MaineHealthACO.org, and clicking the annual report button.

Mike Clark: Well, it's time for The Sizzle, the segment where we highlight the good work of ACO participants. This month, I talked to one of my colleagues in the Lincoln County area who I thought did a really great job of keeping all the providers in the region informed and aligned around the common response. That is Dr. Andy Ross, VP for medical affairs at Lincoln Health. Here's the interview I recorded earlier with Andy.

Mike Clark: Andy, thank you for being willing to talk with me today. And I was just wondering if you could just start with just letting us know a little bit about your current role at LincolnHealth and your background that brought you to this point.

Andy Russ: I came here 15 years ago to be a general pediatrician in a small town on the coast of Maine, and I've sort of described myself as a reluctant leader. And that doesn't mean that I don't enjoy doing what I do. But I certainly never envisioned being, I certainly, I don't still know what a vice president of medical affairs does exactly, but I'm really sort of relishing the opportunity to be involved with responding to the tremendous challenges of the pandemic, which has been, for many people, the challenge of a lifetime.

Mike Clark: Thank you. So to that end, how did your job change as the pandemic unfolded almost a year ago or about a year ago?

Andy Russ: Yeah, well, my my job changed dramatically overnight, really. At the time I had been splitting my time 50/50 between clinical medicine and administrative medicine. And at that time, administration meant sort of planning for quality metrics and strategic planning and budget plan. All of those things that you think of when you think of administration. And then all of a sudden, obviously, our focus shifted. And thankfully, I have a great pediatric team here at Lincoln Health. So I was able to within a week of responding to the beginning of the pandemic, I was able to give up my clinical time temporarily to devote fully to planning our local response to the pandemic. So I'm thankful for the support that my team gave me. But it was a pretty dramatic, really overnight shift in what my responsibilities were.

Mike Clark: What if you look back at those early days and weeks? Are there any leadership challenges that you face that sort of rise to the top?

Andy Russ: One of the greatest challenges, I would say, was the need for communication in the face of uncertainty. In the early days, nobody had answers to anything. And so trying to communicate to various groups, whether it was patients or families or staff members or other leaders, what we were going to do this afternoon or five minutes from now when we didn't know whether we were going to have enough PPE or whether we were going to be able to test anybody or any of the things that were unknown in the early days didn't lessen the need for people to have some form of communication. So I think, and again, hopefully we'll get a chance to talk about it, but we really tried very hard to communicate as regularly as we could with as much information as we had to as many different groups as we as we could.

Mike Clark: Absolutely, I, having been a provider in the Lincoln health area, being part of your medical immediate medical community, I definitely benefited from those communication efforts. And one among several efforts and several initiatives you did that rise to the top in my mind, is the daily email that you and LincolnHealth's CMO Tim Fox would put together to tell the story of that a little bit.

Andy Russ: Well, honestly, I think it really came about as Tim Fox and I were trying to, in our own minds, get a sense of what we had just come through in a given day. And so MaineHealth stood up a hospital incident command system, HICS, and then LincolnHealth stood up its own hospital incident command system, which basically brought a lot of decision makers to one room or one area to try to deal with the deluge of information that was coming in and going out basically all day long. And Tim and I needed a way to sort of organize all of the issues that we dealt with in any given day. And it almost arose organically. It became a way for us to organize our thoughts and then communicate those thoughts out to the group, primarily the providers, the LincolnHealth providers, and then also independent providers like yourself in the community and then other health care leaders. And so it wasn't any masterful design in the beginning. It was just a way to keep our heads above water. But it developed a little bit of a structure in it and sort of a pattern as time went on. And it became for us a great tool for both providing information to people and also soliciting feedback from you and others and people who are looking for information.

Mike Clark: It was really effective and, in my experience, it went beyond just the succinct data keeping us informed each day, I think, maybe even because I was an independent provider in the community, it felt a little bit like a lifeline to you guys to LincolnHealth, to my colleagues. And I think that was helped by the fact that there was a little bit of humor. There was a personal touch that you guys brought to that. Tell me about how at the end of each email, you guys would add on a human interest or personal piece.

Andy Russ: Yeah, well, I'm looking at sort of the structure, the template that we ended up using sort of as we got further into it. It began with a system update -what's going on at the MaineHealth level and then a testing update. Where are we with testing? Do we have testing capability or not? And then a PPE update and then we'll get into sort of staffing updates and surge updates and all sort of the specific, clinical updates, if there were any. And those clinical updates were few and far between in the early days, as you recall. And then at the end, we try to wrap it up with a silver lining sort of in all this. What do we, what can we be thankful for? Sort of the ability to get together and pull together was a silver lining. We would give a shout out to one particular person in the community or one particular team who really went above and beyond. We'd solicit some feedback from everybody and then we'd include a poem or a picture. I think on the day that John Prine died, we shared a link to one of his songs. And it was just an attempt, I think, to humanize the experience for all of us. And yeah, we tried to include some humor in it because certainly people were tired of too many graphs and too much bad news. So we felt like we needed to have a little help to get people to pay attention every night.

Mike Clark: It became something we looked forward to. I would even read it out loud to my wife in the evenings. And it was a way to kind of help us find our way during just an unprecedented time. And it was very, very effective. So, you wear and have worn many hats during this year including medical director or medical adviser position at our local high school, Lincoln Academy. How is that responsibility folded into all of this and challenged you?

Andy Russ: Obviously, in the face of the pandemic, the demands on our time as medical advisers to all of the local school communities really dramatically increased. And I think one of the great, again, silver linings maybe is that we have put together a team of people, both nurses, administrators, school nurses, school administrators, who get together on a fairly regular basis to talk about some of the issues that are facing the school communities and figuring out ways that we as a health care system can support them. And so just putting this team together, we call it the SCHAC, which is the School and Community Health Advisory Committee. But the SCHAC has really been a place where folks can just come together and congregate and share ideas, because, again, we are, however, many months into this pandemic and still there's new information coming out every single day.

Mike Clark: Speaking of the silver linings, we certainly have come through a once-in-a-lifetime, once every hundred years, hopefully, pandemic together and as a medical community I think in some ways our relationships have strengthened and we've come to respect and learn from each other during a really difficult time. And I just want to say thank you for all you've done. And I will never forget the leadership that you brought to our community during this pandemic. And also, thank you for being willing to go on the microphone and unpack your story a little bit with us today.

Andy Russ: Well, thank you.

Julie Grosvenor: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, MaineHealthACO.org/BACON. If you have questions, comments or suggestions, we'd love to hear from you. Please email us at BACON@MaineHealth.org. That's BACON@MaineHealth.org.

Mike Clark: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us.

Julie Grosvenor: See you next month.