ACO Development in New Jersey: One CMO's Learnings from First-Stage Efforts

There are 33 quality measures in the MSSP program. They fall into three major buckets: clinical, patient satisfaction, and utilization measures; and CMS puts them into four different domains. And those 33 quality measures are objective measures of quality. They tend to focus as diabetes, CAD, and CHF. And the data bundles that CMS prescribes are actually pretty clear and well-represented measures of those disease states. They’re tried, true and tested measures.

Have there been any biggest challenges working with CMS?

I hesitate to be too critical of CMS for a variety of reasons, and one is that everybody in the program is learning, which is good. It’s all about everybody learning together; and CMS hasn’t actually done a program like this before. And they’re bringing people in from around the country, and it’s about learning, not criticisms.

What have the main strategic IT challenges been?

Well, I think the IT challenges are made more difficult if you go about building the IT infrastructure yourself. We decided we would partner with a consulting team to get the show up and running. While we were focused on getting the ACO put together, they were focused on putting together the infrastructure and analytics elements.

What are other ACO leaders saying to you, and what are you saying to them, at this stage?

I was actually interviewed as part of a group of five ACO leaders, and there were amazing similarities. We all recognize how important data is to advancing the quality of care. And so ensuring that your IT infrastructures and analytics are as robust as possible, is incredibly important, because you need to be able to improve the care that those measures represent.

Do you think some of the trade press coverage has given an impression that is darker than the reality?

The coverage is valuable, because we’re all learning together. And because of that, you get disparate information, right? I try to be as concrete and clear as possible. And no one’s ever done this before. If healthcare had already been fixed, and it was running like a smooth engine, we wouldn’t even be dealing with these challenges. But we are dealing with them, because healthcare is largely inefficient, and we have the opportunity to improve value through improving care quality at the same or lower costs.

What do you see happening for your own two ACOs and ACOs across the country, in the next two years?

We’re all going to get a lot better. We have never as an industry had our hands around data that rates the performance on specific measures outside the hospital. This is revolutionary. And if you don’t have the data, you can’t get your arms around that challenge. And we’re getting our arms around the data. So where will we be? And critics have suggested that ACOs will be gone in two years when the program is retired. But the value proposition is here to say. We have to figure out how to get rid of the estimated one-third of the cost of healthcare that is wasteful. And so the conversation will persist long after the term “ACO” is gone.

I got a call from someone not long ago who’s a graduate student and who said to me, “Dr. Slonim, I’ve decided that my career in healthcare is in ACOs.” And I said, “Well, you may have a very short career, but on the other hand, if you focus on how we improve quality, improve patient satisfaction, and lower costs, you’ll have a very long career.”

And to the extent that CMS is driving us to think about these issues, via the ACA [Affordable Care Act] legislation—to the extent that healthcare reform is driving us to think creatively about solutions and to be able to innovate—that’s good for healthcare. And while the CMS MSSP program is just one program, we now have private payers, like Horizon, coming to us, to do the same thing. And it won’t be long before the states, through Medicaid, and the health insurance exchanges, come to us as well. And they’ll continually up the ante in terms of the deliverables. But CMS started the conversation; and congratulations to them to advance the conversation on a national level, and we all have to continue it.

And even at the local, Region 2, level of CMS, I give great credit to our partners. And I’ve been to the White House. And I think people are continuing to reach out to us.

And this morning, we just kicked off our optimization initiative, to take a clinical lens to how the information system works and meets the needs of providers. And rather than look at this through an informatics lens, I want to look at this through a clinical lens.