Ep 8 – Creating a Culture of Improvement and Innovation, with Jen Moore

What this episode covers

MaineHealth Accountable Care Organization (MHACO) serves a uniquely heterogeneous population that is spread across coastal, rural, and urban communities with multiple different cultural components. And they serve the oldest population of all states in the Union! The organization’s ED utilization in its early years was historically around 775 visits per thousand – a significantly high number when compared to other ACOs in the country which were well below 700. At the same time, the ACO was about 10% lower than other ACOs in providing primary care services. Find out how MaineHealth was able to implement a Value Oversight Committee, leverage technology, improve processes, and engage their workforce to achieve nearly $20 million dollars in savings in its first year of contracting with CMS in the Medicare Shared Savings Plan.   In this episode we speak with Jennifer Moore, MBA is the president of MHACO, whose membership includes 10 acute care hospitals and over 1,600 private practice and employed physicians, and manages numerous commercial ACO value-based contracts. These ACO contracts cover approximately 230,000 Medicare and commercial lives. Jen has significant expertise in value-based contracting, ambulatory quality measurement and performance, data analytics, and provider relations activities.  Jen is a board member of the National Association of Accountable Care Organizations (NAACOS) and serves as chair of the NAACOS governance committee. Listen to MHACO’s BACON podcast: https://mainehealth.org/mainehealth-accountable-care-organization/provider-resources/bacon-podcast Bookmarks: 4:24 Introducing an extreme ED Utilization scenario and how the ACO initiated an historic turnaround! 5:57 Jen discusses how critical the Value Oversight Committee (VOC) is pivotal to the success of the ACO 6:48 Diagnosing a Patient Access issue in the ACO with key metrics (ED visits/K and PCP visits/K) 7:30 “Houston, we have a problem” (the ACO was higher than the market in 16 of 17 contracts!) 8:00 Performing a root cause analysis of high ED utilizers 8:41 Loneliness is a major driver of ED use 9:05 Getting stakeholder buy-in for the ED Problem: showing physicians there was actually a failure in the care model by using data 9:44 Finding actionable data and knowing what steps to take to solve a problem 11:28 The importance of flexibility in ACO operations: solving challenges at the local level in each of MHACO’s regions 12:12 Leveraging population health management data, SMEs, and Value Oversight Committee to develop a focused operational tactics 12:30 Selecting tactics for the ED Playbook:  1) Patient Education campaign and 2) Actionable Care Planning 12:50 Implementing the “Where to Go for Care” Patient Education Campaign 14:44 Implementing ED Actionable Care Planning 16:45 Risk Stratification and Predictive Modeling (Johns Hopkins ACG) 19:30 ED Propensity Scoring (Urgent Risk, Impactability, Frequent ED Utilizers, Recent ED Utilizers) 20:00 Capturing Social Determinants of Health Data 21:15 Transitioning from a Centralized to an Embedded Care Management Model 23:50 The “a-ha moment” during the pandemic:  the need for more primary care capitation 24:10 Telehealth deployment during COVID-19 26:50 The importance of Clinical Documentation as a driver of ACO contract performance 28:45 Engaging specialists in clinical documentation 30:35 MHACO’s “heat map” report for Top 10 ACO quality measures 33:30 MHACO’s practice incentive report for other ACO quality measures 34:00 Payer collaboration