September 2023
MHACO’s President Jen Moore introduces the organization’s recently released 2022 Annual Report, which highlights how ACO participants improved quality, reduced over-utilization, and generated substantial value-based care revenue through collaborative efforts among providers, care teams, administrators, and payer partners.
Additional Information
Heather: This is BACON, brief news from the MaineHealth Accountable Care Organization. A monthly podcast for health care providers. I'm Heather Ward.
Mike: And I'm Mike Clark. Heather and I are practicing physicians who participate in the MaineHealth ACO.
Heather: In this episode, MaineHealth ACO president Jen Moore joins us to cover the highlights of the ACO's latest annual report.
Mike: Excellent. I hear the news and that report is pretty darn good, Heather, and let's face it, we can all use some good news, so let's get right to it.
Heather: The ACO's Annual Report is out and the news looks good! Released in August of 23. This latest report takes a comprehensive look at the results from 2022. It includes how we did on quality measures, utilization, and revenue generation from value-based care contracts.
Mike: Heather wait a minute. 2022? Isn't it 2023? Well, that just seems like a long time ago now.
Heather: Yeah, it totally does. But there's a reason that it takes a while. The results are based in part on claims data, and claims data has a very long lag time. So, to get a full and accurate report on the whole year, you just have to wait.
Mike: Okay, I get it. Well, fortunately, to fill us in on all the details, our producer Paul Santomenna, spoke to Jen Moore, president of the MaineHealth ACO.
Paul: Well, thanks for joining us, Jen. My first question is really asking you to reflect back on 2022. So we have performance data now and that's in the report. Can you assess what kind of year it was for the ACO, sort of in general terms?
Jen: Yeah, I think it was a very successful year for the ACO and its participants. In 2022, we were still facing the pandemic, folks had many priorities, and I think what came out of 2022 was focusing on what matters. I think the pandemic really forced us to do that. And fortunately, what we know matters in health care is providing high quality, efficient health care, which is what value-based care is all about. So, if anything, I feel like out of the pandemic, the industry has doubled down on value, and I think we've been able to demonstrate that value-based care is a model for the future.
Paul: You mentioned in the report that '22 was also a period of sort of increased connection and collaboration between the ACO team itself and the ACO participants. Can you talk about that a little bit?
Jen: Yeah, I think there were a lot of ways that we connected in a new way with our participants. And again, some of that came out of the pandemic, learning that we needed to get new tools to people, needed to help them navigate a really a new health care landscape. But moreover, we really were able to produce some reports and engage with our participants in a new way. So one example was the creation of our value report. Our data team worked on a fantastic visualization of quality and utilization opportunities in the data, and we went out, we had been sharing this data, we've always shared the data, but I think what we realized last year is that having that face-to-face conversation around the data was what really mattered and what made a difference. To be able to talk about quality and not just in the numbers, but about resources, and what supports could improve that overall quality performance was really that secret sauce, if you will. And so, we went out to each of our local health systems and our private practices and really engaged with them in a new way. And quality is a little bit easier to talk about. I think utilization can be a tougher nut to crack. And so this value report really gave us that platform to do that. Other ways we engaged were around innovation grants.
Jen: So every year when we're successful in achieving shared savings, we'd like to retain some of that savings to sponsor innovative projects. A lot of value based care is about trying to think about new ways to do things, new ways to deliver high value care. And so through these innovation grants, we can engage our participants to come up with really creative solutions. And so that was another way we engaged. There were really great projects that were put forth last year. Finally, I would say that our partnership with agilon, the BiHiVe Partnership that MaineHealth and agilon have together gives the ACO, which is the value-based vehicle that engages with the BiHiVe, an opportunity to work differently. It's very specific work that we're doing in this particular partnership and required a close collaboration with the MaineHealth Medical Group and with our private practices and really allowed us to get a little bit closer to them and find out again: what are the supports you really need to do this work? How can we better deliver those support? And remember, the medical group is a newly unified group, and so it is also forming its own population health shops. And so, we've really learned how to come together with our participants, leveraging the resources that they have, and then figuring out how we can complement the resources to really provide value.
Paul: Great. Yeah. So, let's take a look at the results that are in the report. We have data in there on quality and utilization and also some financials. Let's start with quality. What's the quality performance sort of overview for '22 in the report?
Jen: Over the past several years, I've been so impressed with the continued high performance and quality given the challenges of managing the pandemic. But 2022 in particular, we still had suppressed visits for primary care because of COVID. And so nationally we saw benchmarks get lowered for quality measures, things like breast cancer screening, colorectal cancer screening. Our rate, our colorectal cancer screening rates were more than six percentage points above the HEDIS 90th percentile national benchmark. That's very significant. HEDIS is a national benchmarking for commercial populations. And to achieve the 90th percentile is fantastic, particularly given what everybody was facing with the pandemic, largely because of our focus with the BiHiVe implementation. We also had a big uptick in annual wellness visits, which for the senior population is a great opportunity to connect with them, make sure that as a practice you're really aware of all of their health conditions so that you can provide them all the supports that they need. So to have that tick up really indicated we had a little bit better access for that population and certainly that's also an opportunity to close those quality gaps. So those together were fantastic. A couple of other measures didn't do quite as well. Things that are so visit-dependent where we did see some of them come down, things like blood pressure control, of course, that's always a tricky measure, frankly, but overall, really good quality results.
Paul: Yeah, and then how about utilization? What did that look like? I think we covered avoidable ED and admits and readmits. Talk to us a little bit about that.
Jen: Sure. And those do tend to be the best indicators of performance for us. So, we do tend to look at what's our admission rate? Is it going up or down? Readmission, of course, is also a measure of quality. So, we pay close attention to that. And for ED visits, focusing on avoidable gives us a sense of what could we have done in a different setting. So we always want to be accessible to our patients. Nobody really wants to be in the ED. If you can go to a primary care or walk-in or even an urgent care center, often that's a better setting for certain types of conditions. And so in 2022, we saw a decrease in avoidable ED-use and we've seen that trending down. So, in this case, we see a 156 per thousand. So, for every 1000 patients, 156 of them went into the ED for an avoidable condition at the end of 2021, compared to 142 per 1000 at the end of '22. So that's a pretty significant reduction in avoidable admissions.
Jen: Now we see the acuity of the ED cases going up and we're looking carefully at that. In some cases, that's logical. Right as you as you move the lower acuity patients to the right settings of care. So now maybe they're going into primary care or walk-ins, urgent care. You'd expect that acuity of the ED visits to go up. But we're watching it carefully because as you know, so many people did not go to the ED, didn't seek care when maybe they needed to. So, we want to make sure that's not exacerbated conditions, although we suspect there's some of that. So, we're looking carefully at the ED rate. But the avoidable rate is a good news story. The admissions have been declining steadily as well as the readmission rate. So, we ended at 84 per thousand readmission rate and that was down from a 90, you know, 90 readmissions per thousand people. And as you know, readmissions is again, it's that that marker that payers will use to say how high quality are you as providers? And we tend to do very well in those admissions.
Jen: I will say that I mentioned utilization being a tough nut to crack and so that'll be our future opportunity, right? And you know, we know that things like care management supports can really help us avoid ED visits and admissions. And so that's a lever, if you will, that we pull. But there are other opportunities and utilization data.
Paul: Yeah, well, those, those numbers are quite encouraging. I'd say both in quality and utilization, particularly considering the, you know, the state of the health care world these days. So let's look finally at the third metric, which were the financials. So I realize the financials that were sort of realized in '22 often reflected '21 contracts. But why don't you talk a little bit about what we saw with financials?
Jen: Sure. So we earned over $24 million in in shared savings and incentive dollars in value-based care revenue. And that was very significant. We earned only slightly more than that in the 2020 performance year. And I mentioned that because as you know, 2020 had significant reduction in utilization because everybody shut down because of COVID. So we knew that we would have kind of suppressed utilization there. But to have done so well when there was a lot of bounce back in in care in 2021, really to me says that people are embracing value, that they know what it takes to be successful in value based care. So that was quite thrilling. Now, of that $24 million that we distributed in 2022, almost 18 million was given directly to our participants: MaineHealth Hospitals, MaineHealth Medical Group, St. Mary's and private practices. The rest was retained by the ACO. Some of that does go to operating costs and funding the work that we do to support all of you. But a lot of it also goes to fund participant projects that I mentioned before. Some of those innovative projects that we really hope will help us be successful in the future as well.
Paul: Let's take a look at the future. What's happening '22 was a while ago now. What's the rest of '23 and '24 look like?
Jen: Yeah well, we're really building off that value report that I mentioned. So in 2022, that was really our first time out. We learned a lot through our discussions with our participants about what data would be meaningful to them, how to make it actionable so that they would know how to grab on and make a difference in performance and for our patients. We have iterated on that report. It is, I will say, probably the single best engagement tool that we have. We have folks that are dialing directly into this tool. They can go in and they can look at their results and slice and dice it in different ways, and people are really engaged and excited about it. So I'm really excited about how that will play out and how specific we can get about those opportunities and really engaging people in those. And then again, that utilization, that nut to crack that I mentioned, that can be so difficult. Our Value Oversight Committee has named two very specific utilization opportunities for the network that are also just great patient care priorities. And and one is around end-of-life care. We all know that patients at end-of-life would really prefer not to die in the hospital. They'd rather be surrounded by their loved ones at home. Having earlier referrals to palliative care can really foster that and make sure that they're where they want to be at that critical time. One of our initiatives is around referrals to palliative care, early palliative care.
Jen: Ideally, the measure is that we'd like to see at least ten days of hospice care before patients pass, and that's seen to be a good indicator of kind of being in the right place, at the right time. And so, these referrals to palliative care is where we'll start. We'll continue to build on that data, and we've got really fantastic engagement across our entire network on this particular measure. And the second measure is around transitions of care. So, I mentioned those the readmissions rate and how much readmissions are seen as a marker of quality. And obviously no patient wants to get readmitted to the hospital either. So it hits cost, it hits quality, and it hits patient experience. And so, our goal is really to enhance our ability to connect patients back to primary care following a discharge from the hospital, because we know that the chance of them being readmitted is much smaller if you make that connection within a seven-day period of a discharge. So really, so excited about these initiatives. As I said, they kind of check all those boxes for me. And the fact that they're so patient centered makes them really, really feel-good initiatives. But they also will address cost of care, which is just an important thing for us to address so that we can make health care affordable going forward.
Paul: Yeah, it'll be exciting to see how both of those develop over the next few years.
Jen: It sure will.
Paul: It's going to be great work.
Paul: Any last thoughts, Jen, looking back at '22, putting that in the rearview mirror?
Jen: I guess my final thoughts were just that, you know, I've been at this work for some time and we've seen fits and starts. I've never seen the engagement from people in value-based care that I see now. And so, I'm really optimistic for the future. I'm optimistic that we're going to be able to really make a difference in the lives of the patients that we serve. In closing, I really want to do a shout out to all the participants because this takes a village. All of the physicians that do this work to close the gaps in care to the frontline staff, that is, seeing the patients and making sure that they have a good experience. To our staff here at MHACO. To the payers that enable our ability to be paid for providing the right type of care. It's a community. It's working together to make our communities the healthiest in America, and that's what we're about.
Paul: Great. Well, thank you, Jen. Thanks for taking the time to join us. And of course, we'll have a link to the report on the web page for this episode. Thanks, Jen.
Jen: Thank you.
Mike: 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. And if you have questions, comments or suggestions, we'd really love to hear from you. Please email us at BACON@mainehealth.org. That's bacon@mainehealth.org.
Heather: BACON is produced by the MaineHealth Accountable Care Organization. Thanks for joining us. See you next time.
Mike: See you next time.
Mike: And I'm Mike Clark. Heather and I are practicing physicians who participate in the MaineHealth ACO.
Heather: In this episode, MaineHealth ACO president Jen Moore joins us to cover the highlights of the ACO's latest annual report.
Mike: Excellent. I hear the news and that report is pretty darn good, Heather, and let's face it, we can all use some good news, so let's get right to it.
Heather: The ACO's Annual Report is out and the news looks good! Released in August of 23. This latest report takes a comprehensive look at the results from 2022. It includes how we did on quality measures, utilization, and revenue generation from value-based care contracts.
Mike: Heather wait a minute. 2022? Isn't it 2023? Well, that just seems like a long time ago now.
Heather: Yeah, it totally does. But there's a reason that it takes a while. The results are based in part on claims data, and claims data has a very long lag time. So, to get a full and accurate report on the whole year, you just have to wait.
Mike: Okay, I get it. Well, fortunately, to fill us in on all the details, our producer Paul Santomenna, spoke to Jen Moore, president of the MaineHealth ACO.
Paul: Well, thanks for joining us, Jen. My first question is really asking you to reflect back on 2022. So we have performance data now and that's in the report. Can you assess what kind of year it was for the ACO, sort of in general terms?
Jen: Yeah, I think it was a very successful year for the ACO and its participants. In 2022, we were still facing the pandemic, folks had many priorities, and I think what came out of 2022 was focusing on what matters. I think the pandemic really forced us to do that. And fortunately, what we know matters in health care is providing high quality, efficient health care, which is what value-based care is all about. So, if anything, I feel like out of the pandemic, the industry has doubled down on value, and I think we've been able to demonstrate that value-based care is a model for the future.
Paul: You mentioned in the report that '22 was also a period of sort of increased connection and collaboration between the ACO team itself and the ACO participants. Can you talk about that a little bit?
Jen: Yeah, I think there were a lot of ways that we connected in a new way with our participants. And again, some of that came out of the pandemic, learning that we needed to get new tools to people, needed to help them navigate a really a new health care landscape. But moreover, we really were able to produce some reports and engage with our participants in a new way. So one example was the creation of our value report. Our data team worked on a fantastic visualization of quality and utilization opportunities in the data, and we went out, we had been sharing this data, we've always shared the data, but I think what we realized last year is that having that face-to-face conversation around the data was what really mattered and what made a difference. To be able to talk about quality and not just in the numbers, but about resources, and what supports could improve that overall quality performance was really that secret sauce, if you will. And so, we went out to each of our local health systems and our private practices and really engaged with them in a new way. And quality is a little bit easier to talk about. I think utilization can be a tougher nut to crack. And so this value report really gave us that platform to do that. Other ways we engaged were around innovation grants.
Jen: So every year when we're successful in achieving shared savings, we'd like to retain some of that savings to sponsor innovative projects. A lot of value based care is about trying to think about new ways to do things, new ways to deliver high value care. And so through these innovation grants, we can engage our participants to come up with really creative solutions. And so that was another way we engaged. There were really great projects that were put forth last year. Finally, I would say that our partnership with agilon, the BiHiVe Partnership that MaineHealth and agilon have together gives the ACO, which is the value-based vehicle that engages with the BiHiVe, an opportunity to work differently. It's very specific work that we're doing in this particular partnership and required a close collaboration with the MaineHealth Medical Group and with our private practices and really allowed us to get a little bit closer to them and find out again: what are the supports you really need to do this work? How can we better deliver those support? And remember, the medical group is a newly unified group, and so it is also forming its own population health shops. And so, we've really learned how to come together with our participants, leveraging the resources that they have, and then figuring out how we can complement the resources to really provide value.
Paul: Great. Yeah. So, let's take a look at the results that are in the report. We have data in there on quality and utilization and also some financials. Let's start with quality. What's the quality performance sort of overview for '22 in the report?
Jen: Over the past several years, I've been so impressed with the continued high performance and quality given the challenges of managing the pandemic. But 2022 in particular, we still had suppressed visits for primary care because of COVID. And so nationally we saw benchmarks get lowered for quality measures, things like breast cancer screening, colorectal cancer screening. Our rate, our colorectal cancer screening rates were more than six percentage points above the HEDIS 90th percentile national benchmark. That's very significant. HEDIS is a national benchmarking for commercial populations. And to achieve the 90th percentile is fantastic, particularly given what everybody was facing with the pandemic, largely because of our focus with the BiHiVe implementation. We also had a big uptick in annual wellness visits, which for the senior population is a great opportunity to connect with them, make sure that as a practice you're really aware of all of their health conditions so that you can provide them all the supports that they need. So to have that tick up really indicated we had a little bit better access for that population and certainly that's also an opportunity to close those quality gaps. So those together were fantastic. A couple of other measures didn't do quite as well. Things that are so visit-dependent where we did see some of them come down, things like blood pressure control, of course, that's always a tricky measure, frankly, but overall, really good quality results.
Paul: Yeah, and then how about utilization? What did that look like? I think we covered avoidable ED and admits and readmits. Talk to us a little bit about that.
Jen: Sure. And those do tend to be the best indicators of performance for us. So, we do tend to look at what's our admission rate? Is it going up or down? Readmission, of course, is also a measure of quality. So, we pay close attention to that. And for ED visits, focusing on avoidable gives us a sense of what could we have done in a different setting. So we always want to be accessible to our patients. Nobody really wants to be in the ED. If you can go to a primary care or walk-in or even an urgent care center, often that's a better setting for certain types of conditions. And so in 2022, we saw a decrease in avoidable ED-use and we've seen that trending down. So, in this case, we see a 156 per thousand. So, for every 1000 patients, 156 of them went into the ED for an avoidable condition at the end of 2021, compared to 142 per 1000 at the end of '22. So that's a pretty significant reduction in avoidable admissions.
Jen: Now we see the acuity of the ED cases going up and we're looking carefully at that. In some cases, that's logical. Right as you as you move the lower acuity patients to the right settings of care. So now maybe they're going into primary care or walk-ins, urgent care. You'd expect that acuity of the ED visits to go up. But we're watching it carefully because as you know, so many people did not go to the ED, didn't seek care when maybe they needed to. So, we want to make sure that's not exacerbated conditions, although we suspect there's some of that. So, we're looking carefully at the ED rate. But the avoidable rate is a good news story. The admissions have been declining steadily as well as the readmission rate. So, we ended at 84 per thousand readmission rate and that was down from a 90, you know, 90 readmissions per thousand people. And as you know, readmissions is again, it's that that marker that payers will use to say how high quality are you as providers? And we tend to do very well in those admissions.
Jen: I will say that I mentioned utilization being a tough nut to crack and so that'll be our future opportunity, right? And you know, we know that things like care management supports can really help us avoid ED visits and admissions. And so that's a lever, if you will, that we pull. But there are other opportunities and utilization data.
Paul: Yeah, well, those, those numbers are quite encouraging. I'd say both in quality and utilization, particularly considering the, you know, the state of the health care world these days. So let's look finally at the third metric, which were the financials. So I realize the financials that were sort of realized in '22 often reflected '21 contracts. But why don't you talk a little bit about what we saw with financials?
Jen: Sure. So we earned over $24 million in in shared savings and incentive dollars in value-based care revenue. And that was very significant. We earned only slightly more than that in the 2020 performance year. And I mentioned that because as you know, 2020 had significant reduction in utilization because everybody shut down because of COVID. So we knew that we would have kind of suppressed utilization there. But to have done so well when there was a lot of bounce back in in care in 2021, really to me says that people are embracing value, that they know what it takes to be successful in value based care. So that was quite thrilling. Now, of that $24 million that we distributed in 2022, almost 18 million was given directly to our participants: MaineHealth Hospitals, MaineHealth Medical Group, St. Mary's and private practices. The rest was retained by the ACO. Some of that does go to operating costs and funding the work that we do to support all of you. But a lot of it also goes to fund participant projects that I mentioned before. Some of those innovative projects that we really hope will help us be successful in the future as well.
Paul: Let's take a look at the future. What's happening '22 was a while ago now. What's the rest of '23 and '24 look like?
Jen: Yeah well, we're really building off that value report that I mentioned. So in 2022, that was really our first time out. We learned a lot through our discussions with our participants about what data would be meaningful to them, how to make it actionable so that they would know how to grab on and make a difference in performance and for our patients. We have iterated on that report. It is, I will say, probably the single best engagement tool that we have. We have folks that are dialing directly into this tool. They can go in and they can look at their results and slice and dice it in different ways, and people are really engaged and excited about it. So I'm really excited about how that will play out and how specific we can get about those opportunities and really engaging people in those. And then again, that utilization, that nut to crack that I mentioned, that can be so difficult. Our Value Oversight Committee has named two very specific utilization opportunities for the network that are also just great patient care priorities. And and one is around end-of-life care. We all know that patients at end-of-life would really prefer not to die in the hospital. They'd rather be surrounded by their loved ones at home. Having earlier referrals to palliative care can really foster that and make sure that they're where they want to be at that critical time. One of our initiatives is around referrals to palliative care, early palliative care.
Jen: Ideally, the measure is that we'd like to see at least ten days of hospice care before patients pass, and that's seen to be a good indicator of kind of being in the right place, at the right time. And so, these referrals to palliative care is where we'll start. We'll continue to build on that data, and we've got really fantastic engagement across our entire network on this particular measure. And the second measure is around transitions of care. So, I mentioned those the readmissions rate and how much readmissions are seen as a marker of quality. And obviously no patient wants to get readmitted to the hospital either. So it hits cost, it hits quality, and it hits patient experience. And so, our goal is really to enhance our ability to connect patients back to primary care following a discharge from the hospital, because we know that the chance of them being readmitted is much smaller if you make that connection within a seven-day period of a discharge. So really, so excited about these initiatives. As I said, they kind of check all those boxes for me. And the fact that they're so patient centered makes them really, really feel-good initiatives. But they also will address cost of care, which is just an important thing for us to address so that we can make health care affordable going forward.
Paul: Yeah, it'll be exciting to see how both of those develop over the next few years.
Jen: It sure will.
Paul: It's going to be great work.
Paul: Any last thoughts, Jen, looking back at '22, putting that in the rearview mirror?
Jen: I guess my final thoughts were just that, you know, I've been at this work for some time and we've seen fits and starts. I've never seen the engagement from people in value-based care that I see now. And so, I'm really optimistic for the future. I'm optimistic that we're going to be able to really make a difference in the lives of the patients that we serve. In closing, I really want to do a shout out to all the participants because this takes a village. All of the physicians that do this work to close the gaps in care to the frontline staff, that is, seeing the patients and making sure that they have a good experience. To our staff here at MHACO. To the payers that enable our ability to be paid for providing the right type of care. It's a community. It's working together to make our communities the healthiest in America, and that's what we're about.
Paul: Great. Well, thank you, Jen. Thanks for taking the time to join us. And of course, we'll have a link to the report on the web page for this episode. Thanks, Jen.
Jen: Thank you.
Mike: 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. And if you have questions, comments or suggestions, we'd really love to hear from you. Please email us at BACON@mainehealth.org. That's bacon@mainehealth.org.
Heather: BACON is produced by the MaineHealth Accountable Care Organization. Thanks for joining us. See you next time.
Mike: See you next time.