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Episode 23 – March 2021: The ACO’s Latest Performance Results

March 2021

MaineHealth ACO President Jennifer Moore reports on final cost, quality and utilization results from value-based contracts that settled in 2020. Also, LincolnHealth’s Timothy Goltz, MD, on the power of poetry to improve meetings.  

Julie: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, a cold-brewed monthly podcast for health care providers. I'm Julie Grosvenor.

Mike: And I'm Mike Clark. Julie and I are practicing physicians and liaisons with the MaineHealth ACO. In this episode, we'll hear from a provider who puts a poetic spin on his meeting facilitation.

Julie: But first we'll ask MaineHealth ACO President Jen Moore how the ACO is performing. Is care quality improving? Is utilization down? Have we achieved any cost savings?

Mike: So that's coming up right now. So let's dig right in.

Mike: Well, hi, Jen, and welcome to BACON.

Jen: Hi, Mike. Thanks so much for having me. Happy to be back.

Julie: So, Jen, the ACO recently received performance results for its 2019 value-based contracts, and that's why we invited you to join us. Now, since 2020 lasted about six years, 2019 has been a while ago. So I understand that contract settlement takes time, and I'm happy to have you here. Tell us, how is our performance measured on these contracts?

Jen: Sure. Well, first, just to set some context, it's worth noting that we have over 240,000 beneficiaries that are attributed to MaineHealth ACO providers, and those lives represent over 1.6 billion dollars in health care expenditures. So, you know, it's really important work that we're doing in managing these contracts. And the value-based agreements typically come in three forms. Most typically, we have a shared savings opportunity. So we have a financial target that's based on our historical performance and that we're assessed against. So if our expenditures come in under that target, then we have savings that we can share with the payer. Those savings are typically adjusted by quality performance, so quality is equally important in our performance. Alongside the shared savings opportunities, we also have pay-for-performance opportunities and those come in two forms. One is at an ACO level, so, based on the success of the entire network. And then we have practice incentives based on practice level performance. So I'll be able to share all of those with you today.

Mike: That's a good way to sort of tee this up, Jen. And well, why don't we take a look at quality first in 2019. What kind of quality performance did we achieve?

Jen: Sure. Well, we earned almost 10 million dollars in pay-for-performance incentives. We had, the ACO earned 5.2 million dollars of opportunity and the practices earned 4.5 million dollars in opportunity. That just really represents a lot of hard work closing quality gaps. And really, I believe we have a culture now of improvement. When I think back, Mike, to when we started this work in 2003, you'll remember, we we set up our CIR, the Clinical Improvement Registry, and that was really the beginnings of population health management. We learned how to capture a population, how to document the measurement, and then how to how to bring people in that weren't having their gaps closed. And and I think this performance demonstrates that we've made a lot of strides in these years.

Mike: Yes, we've come a long way.

Julie: Yeah, that's great. But how about utilization? How do those results look?

Jen: Yeah. So utilization, we beat the market trend and many of our contracts that had shared savings. And so what that means is that our utilization was less than expected. I think what we're seeing is a really strong performance in the areas that we've been focusing on for so long, including avoidable inpatient admissions and avoidable ED visits. And we're seeing that success play out in our contracts.

Mike: So in regards to that success, the bottom line: financial performance, how did we do?

Jen: Yeah, so in addition to the almost 10 million dollars that we got in the pay-for-performance incentives, we got an additional 5.6 million dollars in the shared savings, and that is more than double what we had in the previous year. So I think that is really demonstrating some some hard work on the part of all of you, our network providers.

Julie: Well, that's incredible and certainly a lot of people to do a lot of great work, what what do you think were the biggest factors that impacted our performance overall?

Jen: Yeah, so I think the two greatest factors were, again, that decrease in utilization, that focused effort that we had on cost of care. And then the other major factor is clinical documentation. So we are getting better and better at making sure that we document all open clinical diagnoses and we're getting better at that. We, most of our contracts compare us to a network average. We're not quite exceeding the average, but we're closing the gap with the network. So that absolutely impacts our results and impacts our financial targets, which makes it easier to succeed. It better reflects the cost of care that our population is expected to achieve.

Mike: Well, that's great. I mean, it's looking at this from sort of that 20, 30,000 foot level. Makes me wonder, though, you know, what can an individual provider or practice do to to impact the performance of our network?

Jen: Yeah, I think our performance this year demonstrated that the three tactics that we have put forth to our network continue to be the single greatest drivers of performance. And those tactics are achieving quality measures. So, many of you have seen our our quality heat map that's posted on our website regularly. So, if you're not familiar with it, you should absolutely look at it. Focus on those top quality measures, impacts those people, pay for performance dollars that I mentioned, but it also impacts the level of shared savings that we can participate in. And, of course, it's the right thing to do for our patients. The second tactic is managing utilization and costs. We, as I've mentioned, have been focusing on reducing ED visits and avoidable admissions, and that has proven to be very successful, it's still a really important strategy and finally, accurately representing the health of our patients through through complete clinical documentation. Those three tactics are proving to be the reasons why we have been successful this year.

Julie: So it sounds like we did really have a great financial performance. But, you know, other than just dollars, what does that actually mean? How does that help our our patients or our providers?

Jen: Yeah, it's a great question. Our contracts are structured around achievement of the Triple Aim, which is all about the patients at the end of the day. So if we're successful in curbing the cost of care, in increasing the quality of care and improving the patient experience, that's a win win for everybody. Curbing the cost of care, when we achieve shared savings, that's what we've done. And that will translate to, hopefully, if not lower premiums, at least not increasing premiums for our patients and will also help our employers who are footing the bill for so many of these costs. That helps the entire community. We're in it together and our payor partners want this, want this as well. So we really partner together to make this happen because if they can put a product out there that is affordable, that's that's what this is all about, making insurance affordable to more people.

Julie: That's great. Jen, I appreciate you walking us through all of this good news. And so any final thoughts from you?

Jen: Just thank you for all of your work and for all of the network's work. It takes a village to get this work done. Hopefully, and if the ACO can be helpful in the provision of data or insights that help you to do the work you do every day, please don't hesitate to let us know. That's what we're in the business to do. And it takes a partnership to do it.

Mike: It certainly does. Jen. Thank you for joining us. And thank you for the partnership with the ACO, including with small practices like mine. You've made a big difference for us. And we we all appreciate you, the work you do and for taking the time to speak with us today. Thanks, Jen.

Jen: Thank you.

Julie: Thank you, Jen. It's time for the Sizzle, the segment where we highlight the good work of ACO participants. This month, our producer Paul Santomenna spoke to Tim Goltz, a family medicine physician at LincolnHealth who has discovered how a poem, yes, a poem, can set just the right tone for the beginning of a meeting.

Tim: So currently, what I do with poetry is I read a poem at the beginning of several meetings that we have at LincolnHealth, and it started several years ago, I think, after I heard a piece on public radio where they were talking about using poetry at the beginning of meetings, and I started reading poems twice a month at meetings that I ran. And at first, I think people found that it was kind of funny, but then people began to accept it and I think enjoy it,

Paul: What's, what kind of, do you discern a difference in the tone of the meeting?

Tim: Yeah, absolutely. I mean, I think that, you know, when you start with a poem, there's a couple of big benefits. One is that people are more centered. And and also that I think there's more civility. You know, part of the reason I reached out to the BACON podcast is I really feel that this is an idea that would be worth spreading throughout MaineHealth. I think that every meeting should start with a poem.

Paul: Yeah, I would imagine people, the initial reaction of some people would be, oh, we don't have time for that, that's a nice little extra, right? How would you respond? How would you respond to that?

Tim: Well, I mean, because I've intentionally made the poems short. It rarely takes more than a minute for people to hear the poems once in a while. I indulge myself and read a poem that takes several minutes, but it really doesn't take much time out of the meeting and and also I think it has another benefit that it encourages people to be there right at the beginning of the meeting.

Paul: You think people are coming to . . .

Tim: Yeah, I know, I know that's the case for some meetings. Yeah. Now, there may be people who purposely avoid the poems, they're not for everybody, but I think many people find it meaningful.

Paul: And what are you finding for sources?

Tim: I find a little bit on the Internet, but mainly I've scoured used bookstores and I have quite a collection of poetry books at home. I think I have all the books that Garrison Keillor put out and he's been a great source. I've had the good fortune of interacting with our poet laureate Stuart Kestenbaum, and he's been a source of some poems for me. But I also had the great fortune of having several incredible English teachers during high school and then also during college that made me interested in a variety of poets. So there's a lot to reach for this. There's actually way more great poems out there than I'll ever have the time to read.

Paul: Can you give me an example of something that particularly resonated with the folks at a meeting?

I can and actually I came prepared to read a poem I'd like to share. But I think it's almost certainly my favorite poem. And I think it's it's a great poem. It's a great poem for everyone, but I think it's especially resonant for those of us who work in health care. The poem is called Otherwise and it's by Jane Kenyon. And it goes like this. (poem)

Paul: Do you have any advice for other folks running meetings who may want to start incorporating poems into the beginning?

Tim: Well. I think just do it. Don't be bashful about it. I think be a little bit mindful about your audience. You know, I am not a poet. I don't, I probably haven't written a poem in 30 years. So I like to read a lot of poems. And I'm sure that every poem has some value. But I would say that you have to be prepared to read a fair number of poems before you find ones that are really going to resonate with a wide number of people. So I'm sure that I read at least 10 poems for every one that I choose to share at a meeting. But mainly the idea is that I think I'm trying to to foster a degree of mindfulness and just, you know, remind people of the shared humanity that we have with each other and with our patients.

Mike: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and on our Web page, MaineHealthACO.org/BACON. And if you have questions, comments and suggestions, we really would love to hear from you. Please email us at BACON@mainehealth.org. That's BACON@mainehealth.org.

Julie: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us. We'll see you next month.

Mike: See you then. Thanks.