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In St. Paul, Documented Patient Outcomes Improvement in MSSP ACO Development

March 22, 2016
by Mark Hagland
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Dr. Tim Hernandez, medical director of the Community Health Network in St. Paul, shares documented—and rewarded—progress in care management
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The Community Health Network (CHN) is an accountable care organization (ACO) that was formed three years ago as a participating ACO in the Medicare Shared Savings Program (MSSP) for ACOs. Community Health Network was created by a partnership of the four-hospital HealthEast Care System (including the HealthEast Clinics), the Entira Family Clinics, and independent medical specialists in Minnesota. It is located in St. Paul, Minnesota, and serves 14,000-15,000 patients through the MSSP program, while serving 300,000 patients and consumers in the greater St. Paul metro area in general. CHN’s leaders have been partnering with the Chicago-based Pharos Innovations, using one of that company’s core population health management solutions, in moving forward in its ACO work in the MSSP program, sponsored by the federal Centers for Medicare & Medicaid Services (CMS).

Tim Hernandez, M.D., CHN’s medical director, is a practicing family physician who practices three-quarters-time, and fulfills his CHN administrative duties as well. He spoke recently with HCI Editor-in-Chief Mark Hagland, regarding CHN’s progress so far. Below are excerpts from that interview.

How long have you been in medical practice, and how long an administrator?

I’ve been in practice for nearly 28 years, and I’ve been doing administrative work about 20 of those years.

Tim Hernandez, M.D.

When did the Community Health Network (CHN) officially join the MSSP program?

We jointed officially on January 1, 2013.

How many covered lives are involved?

It varies a bit, but it’s approximately 14,000-15,000.

And how many physicians are in Entira?

Around 63 physicians and another 14 mid-level providers.

What led you and your colleagues to choose Pharos Innovations as a vendor partner?

When we started our MSSP ACO, and started to get our data, we began to segment our populations into various segments by cost and claims, and then by medical conditions, and then we overlaid the two. It took a while to get a data dump, and then a while to begin to use analytics in a meaningful way. So the first quarter of 2013. And it became clear to us, and it’s pretty universal based on other conversations I’ve been a part of, that a small percentage of our patients were driving a large percentage of our cost. And so that’s when we stumbled on the ones that CMS is promoting in terms of cost reduction and clinical outcomes improvement: heart failure, diabetes, vascular disease, and COPD. So we said, what sorts of interventions can we do, particularly around patients with high acuity? That’s when we started interviewing various vendors to develop some higher-level stratification, and that’s when we were introduced to Pharos Innovations.

When did you go live with Pharos?

It was during February 2014.

What things have you learned so far on your organization’s journey?

Well, of course, that data is always at least a year behind; and when you get your reconciliation from CMS, it’s something like a year and a half behind. In fact, our first year, we didn’t get ours until August. And so our hospital system at HealthEast and medical staff here, were already doing a lot of work on readmissions. Our first year we saved about $1.4 million, but that wasn’t enough for shared savings. You have to hit a certain threshold of savings. And our threshold was 2.8 percent; we were like at about 2.4 percent, just below it. The second year, 2014, after the intervention, we saved about $5.5 million. We don’t have the 2015 results back yet. Our first year, our reconciliation for 2013 came about August 2014. Last year, it was about July 2015 for 2014. That’s one of the frustrating parts of being an ACO.

The reconciliation is the metrics that are shared with you by CMS, correct?

Yes, you get all the claims adjudicated, and they look at your threshold, your comparative groups, and then the other piece is that you need to hit a certain percentage of your quality metrics.

You obviously did achieve shared savings for the second year?

You’re allowed to share 50 percent, but the 50 percent is then weighted by your quality metrics. Fortunately, we’ve been doing well there. We were in the top 15 of 500 MSSPs from a quality standpoint; we hit 93 of the 33 quality measures, and then they take that and multiply it, and we got a little over $2.2 million in shared savings in the second year.

What were the clinical intervention breakthroughs that helped your organization achieve shared savings in the second year?

The most targeted intervention was using Tel-Assurance software. It’s a program set up to trigger a person, and then there are a number of protocols—Pharos had shared some of theirs with us, and we had some of our own. So once someone was highlighted as a potential admission or readmission. What our data has shown is that, using our own MSSP population as a control group, that patients enrolled in Pharos have significant reductions in admissions, in ED visits, and in readmissions.

To what do you attribute such progress?