June 15, 2023
An Introduction to the McLaren ACO
CMS is requiring Physician Accountability for Cost, Quality, and Patient Satisfaction. The goal of our ACO is to support our providers with the people, processes and technology to effectively and efficiently improve patient outcomes and quality of care in our communities. We are looking for engaged, high quality and cost-efficient providers to partner with us to further develop our preferred provider network for value-based care delivery.
Building an effective ambulatory population health management strategy is a requirement to continue to provide services to our patients and payors. Providers need to focus on the health of their patients (HEDIS metrics) and the management of chronic illnesses from the patients’ home setting.
Keys to being successful in the McLaren ACO:
- Adoption of PCMH (Patient-Centered Medical Home) capabilities by PCPs and PCMH-N (Patient-Centered Medical Home – Neighbor) principles by specialists.
- MPP staff to assist with practice workflow, quality gap closure, managing patient transitions of care and chronic illness.
- Utilization of our Population Health software, Persivia – offers HCC coding support, care coordination, patient disease registry, payor quality data.
- Utilization of McLaren Healthcare System and McLaren Physician Partners (MPP) Providers
- Utilization of the preferred SNF network
- Attention to Hierarchical Condition Categories (HCC) – Utilize Persivia software to integrate HCC coding into Electronic Medical Records.
- Electronic submission of quality data to payors, improving all HEDIS and key performance metrics above the 90th percentile.
Physician/Patient Benefits:
- Management of chronic disease from the home
- Additional provider reimbursement
- Care Coordination access and program across multiple payors to assist in management of complex patients
- After hours and weekend access to Care Coordination
- Remote patient monitoring devices
- ESRD (end stage renal disease) care management program
- Transitional Care Management with Medication reconciliation
CMS and CMMI’s objectives are to transition all Medicare and Medicaid beneficiaries into accountable care relationships by 2030. Accountable care requires access to and coordination of primary care and specialty care to meet the full range of patient needs. The services listed above are intended to improve patient health and satisfaction, enhance patient outcomes, and address fragmented, costly care.
For an ACO application or more information, contact Kim Hamm, Vice President of Clinical Operations, at kim.hamm@mclaren.org or at (248) 484-4930.