It would be easy to fall into lazy thinking and imagine that most of the innovation in the development and forward evolution of accountable care organizations (ACOs) were taking place in large metropolitan markets long driven by managed care and risk-based payment. In fact, the reality is rather different, and a significant number of patient care organizations participating in the Medicare Shared Savings Program (MSSP) for accountable care are in markets that do not have such histories.
Indeed, one of the more successful organizations participating in the MSSP ACO program has been Coastal Carolina Health Care, P.A., based in New Bern, a smaller city located two hours east of Raleigh, N.C. Coastal Carolina, which cares for more than 30,000 patients, is a multispecialty physician group with 42 physicians and 20 mid-level providers, delivering care to patients in 11 locations. Leveraging the Touchworks EHR [electronic health record] solution from the Chicago-based Allscripts, the leaders at Coastal Carolina have been focusing on such important areas as expanding preventive care (such as ensuring that patients are reached out to proactively to get needed mammographies and colonoscopies. Physicians also use tools in the EHR to measure their own performance.
Among other accomplishments, the Coastal Carolina clinicians have:
- Obtained $1.7 million in shared savings payments from the Centers for Medicare and Medicaid Services (CMS) through their successful participation in the MSSP program
- Reduced emergency department visits by 10-15 percent in one year
- Reduced hospital readmissions by 10-15 percent in one year
- Reduced average costs per patient by 19 percent in one year, resulting in $1.2 milion savings
- Increased preventive screening rates, to levels of 91 percent for mammograms, 94 percent for pneumococcal vaccination, 88 percent for influenza vaccination, and 89 percent for colorectal cancer screening
- Improved clinical outcomes, including bringing down hemoglobin a1c levels above 9, from 18 percent of such patients, to 8.3 percent of such patients
What’s more, all of these accomplishments have taken place within the context of Coastal Carolina’s participation in the advance payment model within the MSSP program, a model that Stephen Nuckolls, the organization’s president and CEO, says has made it possible to participate fully and successfully in the MSSP.
Nuckolls spoke late last fall with HCI Editor-in-Chief Mark Hagland regarding Coastal Carolina’s forward evolution around accountable care. Below are excerpts from that interview.
You have 45 physicians—what is your total medical professional cohort?
Yes, that’s right. We’re a single tax identification number, with about 45 physicians and 15 mid-level providers, some part-time, so we’re 50 provider FTEs. We have about 11,000 attributed Medicare beneficiaries, which is a little above average. We’re also multispecialty—pulmonary, critical care, gastroenterology, cardiology, endocrinology, and neurology.
What made you decide to join the MSSP for ACOs?
I had followed the development of the Affordable Care Act, and there were six pages related to this [ACOs]. And I’ve always wanted to cut out the middleman, and this was a way to do that, to save money for taxpayers, and provide good value. And our group felt that in the long run, this would be the best thing for our patients, and good for us financially. So basically, we felt that if we could get our incentives aligned, that everything else would fall into place. And then the advance funding.
Type in advance payment model ACO, and there’s a two-page document on CMS’ website. But basically, we received a flat payment of $250,000, and then a payment of $36 per attributed beneficiary that was also paid upfront. And so since we had about 11,000 attributed beneficiaries, that came to $370,000, and then the third component was $8 per beneficiary per month, and we’ve gotten 27 payments for ongoing payments, covering for the first 21 months of the program.
We entered the program on April 1, 2012. In terms of what CMS officials do, they go back and adjust the benchmarks based on national growth, and any adjustments in beneficiaries attributed to a particular ACO.
What kinds of outcomes have you been able to document in the program?
In October, CMS released the quality measures, and I knew we were doing pretty well on them; we had implemented several changes in our office, and were tracking our progress. They released a ranking sheet with all 220; and one of my friends had his staff tabulate them. And I was pleased that overall, on the 33 quality measures, we ranked number three among the 220. Some of the measures we did particularly well on were some of the preventive screenings. In fact, on several measures, we ranked number one in the entire MSSP program, including mammograms (91 percent) and colonoscopies (89 percent). And that’s where having the Allscripts solution really helped us. We used the advance payment to fund the purchase of that system, and that really helped us do population health management.
What aspect of the solution particularly helped?