Even as purchasers and payers of healthcare are compelling the providers of healthcare forward into value-based payment models, one area has until now been left completely unaddressed: how to care for the needs of individuals with intellectual and developmental disabilities (IDDs). Such individuals present severe chronic health conditions, usually present at birth, that limit the trajectory of their physical, cognitive and emotional development and opportunity to live in most integrated community based settings.
Meanwhile, the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) continues to move forward, with hundreds of provider groups collaborating to work with public and private payers of healthcare to share savings, while taking care of patients across the continuum of care.
And now, for the first time, an MSSP ACO has been formed to manage the care of individuals with IDDs. That organization is the Alliance for Integrated Care of New York, LLC (AICNY), based in New York City, the first and only MSSP ACO of its kind in the U.S., formed in 2014 to oversee the healthcare needs of individuals with IDDs.
Seven outpatient diagnostic and treatment health centers and 25 licensed private practices affiliated with the Queens County Independent Practice Association (QCIPA) have come together to form AICNY, in order to focus on treating this vulnerable and underserved population. These provider organizations represent a significant footprint encompassing most of New York. Approximately 200 physicians and other healthcare professionals care for more than 6,000 dually eligible Medicaid and mostly Medicare beneficiaries, the majority of whom are IDD patients.
Like the leaders of so many emergent ACOs, the leaders of the Alliance have had to work through numerous dimensions of obstacles in the way of seamlessly capturing and sharing relevant IDD-patient data such as routine and follow-up visits, prescription orders and refills, and longitudinal medical records. In their case specifically, the leaders of the Alliance had been finding it difficult to reduce the unnecessary utilization of resources; for example, a common problem was that so many of their patients with multiple chronic conditions were being needlessly sent to emergency departments multiple times per month, to avoid citations by the government agency responsible for conducting on-site quality reviews.
So the AICNY leaders partnered with the Piscataway Township, N.J.-based HealthEC, in order to aggregate and analyze IDD beneficiary claims onto a population health management platform; risk-stratify and identify patients appropriate for targeted care interventions; and meet quality data collection and reporting requirements, for such programs as the MIPS (Merit-based Incentive Payment System) program under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law.
The Alliance also equipped its participating physicians with dashboards to unify data and compare their performance against pre-established quality standards so they can track care improvements. In addition, to the extent that primary care physicians and specialists could share electronically information from their consults, unnecessary follow-up appointments could be averted—a significant consideration for a population for whom doctor visits can be mentally and physically taxing.
What’s more, in order to better serve New York’s IDD population, the Alliance is integrating medical care management by digitizing their entire residential world of health centers, private practices and ultimately long-term care agencies. Its goal is to build electronic information sharing of pre-service summaries populated with the most relevant documentation accessible for every provider’s IDD patient visit. And, with that in mind, the Alliance’s leaders have spent considerable time creating workflows that can optimize the appropriate sharing of clinical information.
Recently, Healthcare Informatics Editor-in-Chief Mark Hagland spoke with Duane Schielke, the Alliance’s executive director, to gain insights on how this broad initiative is moving forward. Below are excerpts from that interview.
Your headquarters is in New York City, correct?
Yes, we’re based in midtown Manhattan.
Tell me a bit about the history of the Alliance?
AICNY was established in 2014, initially to buy a group of IDD agencies, which included Cerebral Palsy Associations of New York State, where I'm the executive vice president for healthcare initiatives. There's a 5,000-person minimum requirement to be an MSSP ACO. What we found is through the process of attribution, which is quite a complex process, the 5,000 patients that we had identified that are dual-eligible turned out to be not 5,000, because of how the attribution works. Which fortunately is changing next year in a very positive way so the patients can actually self-select. So, we formed the ACO with another group in Queens, and currently, we have seven IDD outpatient clinics; they're the core part of the piece that I'm mostly involved in.