Earlier this month, the New York affiliate of Nuvance Health—a healthcare system with seven hospitals in New York and Western Connecticut—and CareMount Medical, PC, the largest independent multi-specialty medical group in New York State, have collaborated in the New York market on a number of population health-based initiatives.
According to executives at the two organizations, the relationship will support clinical integration and ambulatory collaborative activities of the two entities with the goals of improving quality and reducing costs in the Hudson Valley region of New York. The CareMount Medical group includes more than 650 providers and over 45 locations throughout the Hudson Valley and New York City.
In addition, Nuvance Health, with the support of CareMount Health Solutions (CHS), will launch a Medicare Shared Savings Program (MSSP) accountable care organization (ACO) in its New York market. CHS, a physician-owned management services organization, will deliver to its client, the New York affiliate of Nuvance Health, a suite of population health management services including care coordination and clinical programs, data analytics, financial and actuarial analysis, and quality gap closure. There will be an estimated 10,000 Medicare beneficiaries attributed to the new Medicare ACO in CY 2020, according to officials.
CHS will draw on its experience in running its own successful Medicare ACO, the only physician-owned Medicare Next Generation ACO in the Tri-State area. Participants in the Next Gen program, which began in 2016, have the opportunity to take on higher levels of financial risk than ACOs in other current initiatives. While they are at greater financial risk, they also have a greater opportunity to share in more of the model’s savings through better care coordination and care management.
One of the primary goals of the new partnership, says Kevin Conroy, CareMount Medical’s chief financial officer and chief population health officer, is “to build a first-class, value-based infrastructure that involves data and analytics at its core, with key care coordination aspects that work for both our patients and physicians.” He notes that building out a bigger clinical partnership network with CareMount’s geographic neighbors will ultimately enable better care coordination and data sharing with its nearby providers “to truly bring a holistic approach to our patients.”
CareMount Health Solutions—the MSO aligned with CareMount Medical—houses the organization’s value-based infrastructure, and will work to help develop something similar for the launch of the MSSP ACO in collaboration with Nuvance Health. One thing working in the favor of CHS is that it has already created such a framework for the Next Gen ACO program. It won’t be easy or quick work, though. “It takes a lot of time to build up the infrastructure and also to get your physicians aligned with what the programs are, putting the data in their hands, and putting the report cards and morning huddle reports in their hands so they can excel,” Conroy says.
To that end, in the Next Gen ACO program, one key element has been developing a preferred provider network, or as Conroy puts it, “bringing us closer to providers outside our four walls.” An example of this is through relationships with skilled nursing facilities (SNFs), post-acute care providers that CareMount has 25 contracts with in its Next Gen ACO. “Perhaps the most important piece is that you get to work more closely with these folks,” Conroy says. “So, for example, you have the Nuvance relationship with its hospitals, and we now embed our own care coordinators in their facilities. We have discharge planning coordinators in their facilities, and this is all by agreement; let’s work together to make sure the patient has a good level of experience and is in the right setting at the right time.”
Another important success factor, Conroy contends, is having the infrastructure in place, and up-and-running and operational, before taking on risk-based contracts. “It is so key to have a few things in place,” he stresses: “the analytics; great clinical leadership that can drive behaviors based on the analytics; some sort of alignment from a compensation perspective—an incentive program—; and lastly, communication with patients. We have a robust care coordination team that understands how to reach out and be proactive with the high-chronic users,” he says.
Could CMS move on from the Next Gen model?
Earlier this month, a report from Fierce Healthcare noted that the future of the Next Gen ACO program is in jeopardy as Centers for Medicare & Medicaid Services (CMS) officials have pointed to certain evaluation reports indicating that ACOs in this program haven’t generated savings. Although CMS has said nothing officially yet, the report revealed that some ACOs in the program have already been told that the model will not be renewed in 2021 when the existing Next Gen ACO contracts expire.
There were 50 Next Generation ACO participants for the 2018 program year, and according to data released by CMS in January, they reduced spending by about 1.11 percent in 2018, returning more than $184 million to the Medicare Trust Funds. For 2018, Medicare will pay approximately $285 million as shared savings to ACOs and recoup nearly $64 million as shared losses, the data showed.
But CMS Administrator Seema Verma also pointed out in the announcement of those results that a different evaluation report—one that uses different methods than the actuarial results—revealed that Next Gen ACOs in 2016 and 2017 did not lead to a statistically significant difference in spending. And when looking at just the second performance year, 2017, ACOs in the model actually led to a statistically significant increase in spending of $115.6 million. It should be noted, however, that CMS itself, in December 2018, touted that Next Gen ACO participants generated $164 million in net savings in 2017.
The difference, according to Verma, is that “The evaluation report uses different methods than the actuarial results to retrospectively compare the cost of care for beneficiaries served by Next Generation ACOs to a comparison group not exposed to the intervention.”
The debate over how ACO program savings are calculated is not new, and to many, can seem complex and confusing. But Conroy leaves it up to the government and trade organizations representing ACOs to argue those cost-savings parameters. What CareMount is concerned with, he says, “is using the program as a way to take better care of our patients, invest in the infrastructure, improve outcomes for patients, and reduce costs. From our perspective, the program allowed us to do all that.”
Indeed, CareMount generated $778,583 in shared savings for Next Generation ACO performance year 2018. CareMount ACO was one of a total of 38 ACOs in this program nationally to achieve earned savings for that year as well. Whether or not CMS continues the Next Gen program is not of utmost performance to CareMount, Conroy says, because it will be pushing forward on value-based care one way or the other. “There will be a program for us. Whether CMS decides to extend the Next Gen program, or we migrate toward another program like Direct Contracting Entity, or even MSSP Track 3, we believe we will thrive. We will apply to both Direct Contracting Entity and MSSP Track 3, and we’ll continue the mission we are on from a value-based perspective,” he emphasizes.
The government is still working out the details behind Direct Contracting Entity , which was announced in April 2019 and is scheduled to go live late in 2020. CMS will test two voluntary risk-sharing options in Direct Contracting, the agency recently announced: 1) Professional, a lower-risk option and Primary Care Capitation (PCC); and 2) Global, a full-risk option and either PCC or Total Care Capitation (TCC). Additional information will be provided at a later date regarding a third option. CMS also recently said, “Direct Contracting offers another model option for Next Gen ACO model participants to consider after [the program] ends in 2020,” perhaps signaling that it will not renew the model after all.
Conroy says that while his organization hasn’t yet heard a final decision from CMS on the Next Gen ACO program, “there will be a place for high-functioning ACOs like ourselves to land.”
