Triad HealthCare Network, a subsidiary of Greensboro, North Carolina-based health system Cone Health, is a physician-led accountable care organization (ACO) with a network of more than 1,200 physicians and providers and six hospitals covering patients across five North Carolina counties in what’s known as the Piedmont Triad area, or the north-central region of the state.
In those five counties, Triad HealthCare Network (THN) participates in a number of risk-based contracts with multiple payers, and the contracts vary in ranges of risk from shared savings programs to full-risk contracts. THN covers 84,000 patients through several Medicare Advantage plans (Humana, United Healthcare, Health Team Advantage) and an employer-based plan.
In July 2012, THN was selected to participate in the Centers for Medicare and Medicaid Services’ (CMS) Medicare Shared Savings Program (MSSP) ACO program. According to THN leaders, the organization was ranked fifth in the country for quality in the MSSP ACO program in 2015 and scored 99.8 percent on the required quality metrics for that year. And, as of January 1, 2016, THN was selected to participate in the Next Generation ACO.
As Healthcare Informatics Managing Editor Rajiv Leventhal noted in an article published earlier this month, when CMS announced the Next Gen program early in 2016, the idea was to “build up on experience from the Pioneer ACO model and Medicare Shared Savings Program (Shared Savings Program),” the federal agency said at the time. Indeed, Next Gen model participants have the opportunity to take on higher levels of financial risk—up to 100 percent risk—compared with ACOs in other current initiatives.
CMS released the results of the first year of its Next Gen ACO model in October, which indicated 11 of 18 Next Gen ACO participants were able to earn shared savings in 2016. What’s more, all 18 ACOs in this model scored 100 percent on quality across 33 measures they were graded on. CMS announced that 28 ACOs joined the model for 2017, bringing the total number of Next Gen ACOs to 45.
Based on CMS data, Triad HealthCare Network generated $10.7 million in shared savings in the first year of the Next Gen ACO program, ranking second out of the 18 ACOs that participated in the program in 2016. THN covers 27,780 beneficiaries in its NextGen ACO program.
THN executive leaders contend that technology has been a critical factor in the ACO’s success, specifically patient engagement and care coordination technology tools that help to identify gaps in care and scale patient engagement efforts.
“The other key is having strong physician leadership. Our physicians are truly partnered with us. We feel we are physician-led and physician-managed; our physicians are driving what’s going on and really trying to affect appropriate change in the health care system. So, I think those areas—technology tools and physician leadership—are what’s making a difference for us,” Elissa Langley, director of accountable care operations for THN, says. And, the technology tools and care coordination together have helped to drive significant improvements in clinical outcomes.
Leveraging Technology to Advance Population Health
An interesting detail about Triad HealthCare Network is that while the ACO is a subsidiary of Cone Health, more than 60 percent of the practices and providers participating in the network are independent community physicians and are not directly affiliated with Cone Health, about 40 percent are employed by the Cone Health system.
“Our physicians are on over 30 different electronic medical record (EMR) platforms, so it’s been a challenge over the years to try to aggregate data for so many different disparate systems, but we’ve done a really good job of doing that. And, we’ve been able to report on 34 ACO measures that have been part of the Medicare CMS program,” Langley notes.
However, early in the organization’s MSSP ACO journey, THN executive leaders recognized the organization wasn’t reaching all the patients in most need, disabling the organization from meeting quality metrics necessary to receive payment. In the 2014 and 2015 performance years of the MSSP ACO program, THN did not achieve shared savings as the minimum savings requirement was not met. In order to better engage with its patients and ensure measures are met and dollars are not left on the table, THN worked with Emmi Solutions, a patient engagement software vendor now part of Wolters Kluwer, to implement several technology tools to address gaps in care and improve patient education and engagement.