ACOs are becoming more common, because a shift is taking place in the medical landscape as a result of Obama’s Affordable Care Act: away from traditional fee-for-service payments towards value-based payments. Fee schedules are essentially frozen, additional payments come from “reported” improved quality metrics and cost savings. McLaren desires to offer its aligned physicians business strategies and support to meet the new requirements imposed by Medicare, Medicaid and Blue Cross Blue Shield of Michigan.
This newsletter announces the intention of MPP and MHC (McLaren Health Care) to submit an application to CMS (Center for Medicare and Medicaid Services) to participate in the MSSP ACO (Medicare Shared Savings Program Accountable Care Organization) in January 2017.
MPP will be building the infrastructure and competencies required for success in this risk-based payment model. The initial McLaren ACO contract with CMS will be an MSSP Track 1 which includes upside-risk only for the first 3 years. The measurement period would begin in 2017 with any payment adjustments being realized in 2018.
The McLaren ACO will include MPP members only. Specialist providers can engage with the ACO by providing high quality cost-efficient care and aligning with the MPP Clinical Integration Program.
The McLaren ACO will be comprised of MPP physicians and MHC with any distributions split 50/50 between the providers and the McLaren system.
Benefits of an ACO include:
- Provide higher-quality patient care, improve care coordination and make more cost-efficient health care decisions
- When the ACO saves money thru Care Coordination and Chronic Disease Management by reducing unnecessary procedures, visits and hospital stays, providers share in the savings.
- Joining an ACO can help improve the functioning and profitability of your practice while also increasing patient wellbeing and satisfaction
- Focus on high-cost, chronic illnesses. The real savings for practices that join ACOs lie in chronic-illness cases: the 5 percent of the patient population that generates 50 percent of the practice’s health care costs. Doctors must focus on reducing repeat visits and costly procedures for these patients in order to generate real savings
- Infrastructure support with technology (registries) and personnel (practice coaches)
- No cost to join ACO for MPP members
Becoming a member of the McLaren ACO will allow the ACO to report on the MIPS (Merit-based Incentive Payment System) quality metrics required in 2017 for all participating Medicare providers. MIPS composite performance score aggregation will be at the ACO level and not the individual provider level. Additional benefits include a credit in the Clinical Practice Improvement domain of MIPS.
Requirements to join the McLaren High Performance Network ACO:
- Must be a member of MPP, new members are being accepted
- Must sign an ACO participation contract by Thursday, June 30, 2016
- Utilization of an EHR (electronic health record) and patient registry
- Primary Care practices desire to become Patient Centered Medical Home (PCMH)
- Specialists agree to Patient Centered Medical Home Neighbor principles
- Data sharing
If you have any questions, please contact Dr. Lawrence Cowsill, Senior Medical Director, at Lawrence.Cowsill@mclaren.org or (248) 484-4925 or Leah Searcy, VP of Operations, at Leah.Searcy@mclaren.org or (248) 484-4924.