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A Rare Kind of ACO in the Advanced Payment Landscape

March 1, 2013
by Gabriel Perna
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The Cumberland Center for Healthcare Innovation (CCHI), a physician-driven accountable care organization (ACO) based out of Cookeville, Tenn., isn’t your typical ACO, even though most ACOs aren’t typical themselves.

“We’re kind of rare. Even according to CMS [The Centers for Medicare & Medicaid Services] we’re kind of rare,” admits Frank Ross, the group’s contracted IT advisor.

What makes CCHI so rare? It could be the group’s 39 rural practice physicians or the fact that many of the physicians in the group take on “double duty,” and care for patients in an office setting and in the hospital. Or even more likely, it could be fact that the 39 CCHI physicians have 10 years of experience on average, and those 39 were willing to join an ACO in the first place.

“We don’t have a lot of newbies, we have people who have been in the trenches for a long time,” Ross says. “So what’s even more interesting is we got them to join an ACO. These guys are fiercely independent, and if they don’t have distrust of the government, they are reluctant to be ensnared in government projects.”

Yet, thanks to CCHI’s CMO, Chet Gentry, M.D., the 39 independent physicians showed a willingness to form this union and create the ACO in 2011. In turn, as an Advanced Payment ACO under the Medicare Shared Savings Program, CCHI has received “seed money” from the government to get things going. The money is given up front in the form of advanced payments, which will be partly repaid in the form of shared savings.

Mission to Integrate

Part of the challenge of being an ACO, according to Ross, is figuring out CMS’ various requirements from an information standpoint. In total, there are 33 distinct quality measures CCHI will be evaluated on. Many of these requirements, such as quarterly reporting of clinical and survey data as well as initiative where cost metrics are compared, hinge on comprehensive IT adoption, he says.  

As a result, CCHI is using clinical business intelligence software from the Atlanta-based Clinigence. Ross says of the dozen or so vendors the organization met with, Clinigence was the only one that could extract quality measures from the electronic medical record (EMR). The alternative, he says, was handing the physicians a clipboard and having them essentially do the extraction themselves. Ross also credits Clinigence for providing a web-based, software-as-a-service (SaaS) cloud solution where CCHI can view each practice online and where they stand on the CMS ACO clinical measures.

CCHI is on a mission to “integrate” 14 different types of EMRs from the 39 physicians in the group. In this case, integration means extracting quality information such as demographics and basic continuity of care documents (CCDs). “We focused on the CCDs, because we knew that’s a component an EHR has to provide if they’re meaningful use certified,” Ross adds.  Early on, CCHI is focusing on integrating the EMRs that have the largest concentration, and continuing from there.

Down the line, Ross would like to make use of predictive analytics, and he speaks of a potential alliance with the local university, Tennessee Tech. Predictive analytics is another reason Clinigence was chosen, he says. “Their [Clinigence] commitment to predictive modeling is you have to know the population and you have to know their behavior. And the predictions have to be scaled against to that percent of the population that will be the most unpredictable,” Ross remarks. 

Lofty Goals

The CMS Advanced Payment model is a three-year demonstration, and by the last year, CCHI will be evaluated by its performance on all of the measures. While that may seem lofty, especially with the technology required to make it happen, Ross has high hopes. In terms of integration, he says if a practitioner is working towards achieve meaningful use achievement, “this will be a walk in the park.”

To that point, CCHI has told its practitioners it has to get serious about adopting a meaningful use-certified EMR, if it wants to stay in the ACO. Part of their shared savings distribution comes from whether or not the practitioner has met meaningful use.

“We like to say it’s hard love, and it will painful, because I don’t think some of them were serious about meaningful use. But if you have an EMR that is capable of [meaningful use], you’re halfway there,” Ross says.

If CCHI is successful, Ross would like to see the model get emulated and expanded across the industry. It’s not just providers he is talking about, he mentions the organization is “in talks” with commercial payers to get involved as well. The goal of these programs is to achieve the triple aim— better care, better quality, lower cost—and he says there are a “plethora of companies” that understand the model.

“There is a whole renaissance that can take place if it doesn’t get killed politically. We don’t need to go back to the dark days, to an industry that was not regulated, nor had competition,” Ross says.

Ross says the fact the experienced physicians in his “rare” ACO are willing to go on board, so can anyone.