As of January 1st, 2017, 28 additional organizations began participating in the Next Generation (“Next Gen”) ACO model, bringing the total number of ACOs to 45 – making Next Gen the largest advanced ACO program in Medicare’s history. Interest in Next Gen should not come as a surprise – in addition to qualifying as an Advanced APM under MACRA, the program also offers deal terms that surpass nearly all of the 40+ commercial ACO contracts Evolent has negotiated over the past 5 years.
With the upcoming May 18th application deadline for the final chance to join the Next Generation ACO program, many health systems and physician leaders are carefully evaluating the requirements, risks, and long-term benefits of participating in the program.
To help provider groups make an informed decision, we co-hosted a webinar with one of our partners and original Next Gen ACO participants, Deaconess Health System. During the webinar, Dr. James Porter, Executive Vice President & Chief Physician Executive at Deaconess, shared his perspective on why they entered Next Gen in 2016 and how they have driven positive results in the first year of the program through a partnership with Evolent Health. Click here to view the webinar recording, or continue reading for a recap of major topics discussed:
Background on the Next Generation ACO:
The Next Gen model offers a number of compelling opportunities compared to MSSP Track 1, Track 1+, and Track 3 including:
- Financial terms: Keep up to 100% of the upside savings
- Risk Adjustment: Adjust benchmark up to +3% to accurately depict risk profile
- Prospective Attribution: Early identification to manage attributed population
- Benchmark Timing: Receive prior to start of the plan year
- Network and Beneficiary Incentives: CMS waivers, supplemental benefits, and financial incentives for beneficiaries
In addition to the favorable contract terms, Next Gen also satisfies MACRA requirements for an Advanced APM and provides a safe harbor for punitive pay-for-performance programs (i.e. MIPS). Participation enables PCPs to receive the 5% Advanced APM bonus in addition to access to shared savings for successful ACOs, which creates a compelling platform for network expansion.
Overview Deaconess Health System
Deaconess is a 6-facility system located in Evansville, IN. Deaconess participated in MSSP Track 1 starting in 2012 and launched Next Gen in 2016 in order to:
- Create value and offer incentives to providers
- Leverage favorable contract terms, particularly upside potential and +3% risk adjustment impact on benchmark
- Access benefit enhancements and waivers to enhance care management and patient experience
Deaconess knew to be successful in the Next Gen ACO model, they needed to deploy physician-led, evidence-based clinical programs and market-leading technology to improve the quality and care experience for Medicare beneficiaries. They also needed to build a Risk Adjustment Program to identify beneficiaries with undocumented conditions and support providers to improve documentation and coding accuracy.
What did Deaconess accomplish during the first year in Next Gen?
- Established a physician engagement strategy to include a Governing Board composed of practicing providers, financial incentives linked to performance and leadership training for physicians who typically spend 100% of their time practicing medicine.
- Launched IdentifiSM Evolent’s integrated technology platform to:
- Extract data from disparate systems (claims data from payers, clinical data out of the EMR, and patient-completed data) and combine into data warehouse
- Use predictive analytics to retrospectively and prospectively risk stratify the population to help determine the appropriate care path for high-risk patients
- Provide platform for sharing data back to participating practices and providers in the care continuum
- Enable ongoing monitoring of patient care and quality metrics
- Implemented population health program to identify patients with future, avoidable conditions and engage with well-trained staff around proven techniques
- Complex Care and Condition-specific programs to target the sickest patients with uncontrolled chronic condition(s), assign dedicated Care Advisor and manage over 6 months
- Transition and Emergent programs ease the complexity of moving from one location to the next
- All programs support and simplify care management for PCPs, enable coordination among pharmacists and mental health providers
- Built a Risk Adjustment Program using workflows and tools through Identifi
- Identify documentation gaps through Natural Language Processing (NLP) technology, ensure medical record accuracy to drive care gap closure
- Provide practices with list of suspect conditions for upcoming office visits and utilize coder decision support tool to ensure accuracy
What are some early results and key indicators of success?
Deaconess projects over $7M in gainshare from 2016, which represents 80% of total shared savings1. Next Gen has been critical in helping the overall Value Business reach scale, and has provided a vehicle for physicians to proactively ask to join the ACO network. Some key indicators of success include:
- Network expanded 24% from 2016 to 2017 and currently includes 241 providers managing ~36k attributed beneficiaries
- Implemented 1,500 clinical algorithms / rules and 9 predictive models through IdentfiTM
- Managed 1,324 of the sickest beneficiaries through clinical programs; high patient engagement and positive feedback
- Achieved 110% of Risk Adjustment Goal; benchmark reflects acuity of population
1. Based on preliminary, independent analysis and does not reflect final performance reported by CMMI
How can other ACOs partner with Evolent to offload downside risk?
Many provider organizations are hesitant to move into Next Gen since success is not guaranteed and there are significant financial consequences to poor performance. To support migration to Next Gen, Evolent offers a unique value proposition of combining proven operational capabilities with the ability to offload a majority of the downside risk. This partnership model enables ACOs to benefit from the upside potential of Next Gen while taking on downside risk similar to the Track 1+ Model.
Note: Evolent Next Gen ACO partners include Deaconess Health System, St. Luke’s, Hill Physicians, Indiana University Health, Carilion Clinic and Premier Health. Evolent is also proud to partner with 5 MSSP Track 1 and Track 3 ACOs across the country, representing a combined 11 partners, 320k beneficiaries and over $3.5B in medical expense.
For more information on Evolent’s Next Generation ACO partnership model and fee structure, please contact Chris Dawe directly at Cdawe@Evolenthealth.com.
