Episode 37 – May 2022: Annual Report & Access to Care

Julie: This is BACON, Brief ACO News from the MaineHealth Accountable Care Organization, a flambéed 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.

Julie: In our Sizzle segment this month will celebrate 20 years of Access to Care, the MaineHealth program to meet the needs of underserved patients and populations.

Mike: Yes, but first we explore the MaineHealth ACO's new annual report guided by President Jen Moore.

Julie: Can't wait. Let's get to it.

Mike: So, Julie, it is springtime. And tell me, what are some of the signs of spring you look forward to?

Julie: Oh, boy. Longer days, warmer temperatures, watching things grow. Those are some of the biggies.

Mike: Yep. Those are truly great things that emerge in spring. But Julie, you missed my favorite.

Julie: What's your favorite Mike?

Mike: Well, it is the emergence of the MaineHealth ACO annual report, of course.

Julie: Wow. I do not know how I missed that.

Mike: Yeah, well, okay. To be honest, I think maybe peepers and maple sugar Sunday come before the annual report, but it does show up every year around this time.

Julie: Well, that's right. And here to talk about the new 2021 report, now available at the MaineHealth ACO annual report .com, that's MHACOannualreport.com, is Jen Moore, president of the MaineHealth ACO. Welcome, Jen.

Jen: Thanks for having me. This is representing really exciting work across our provider community. At MaineHealth ACO, we have seen amazing resilience, pockets of innovation in the face of adversity, let's call it let's call COVID adversity. And I think we have lots to share with you today.

Julie: That sounds about right.

Mike: So, Jen, this report looks back at outcomes measured or reported in 2021, including financial quality and utilization performance, as I understand it. So what's the headline for this year?

Jen: I think the biggest headline is that in 2021, we received the highest payout that we've ever received from our contracts. The contract performance in 2020, we earned over $26 million in shared savings, which really represents much more than that in savings, closer to $50 or $70 million in savings across the board. And really proud of that work, particularly again during COVID, and thankful that we have those dollars that we can plow right back into patient care.

Julie: So Jen, in value-based care, increased earnings obviously is a good thing for the ACO. Does that mean that we succeeded in limiting overutilization? Does it mean we maintained high quality? What's this tell us?

Jen: Yeah, we certainly did. We maintained and we actually lowered utilization. And not surprisingly, COVID in 2020 was challenging to get patients in for services and challenging to staff all the services that we wanted to. So we did see some suppressed utilization that contributed to some of our performance, but in many of our contracts, we're actually compared to the market. So even in the face of a market that was facing those same challenges, we did well comparatively. On the quality side, it was challenging to close gaps in care in 2020 for obvious reasons. Having said that, we watched our entire primary care community pivot very quickly to learn how to do telehealth visits, to learn how to try to close those gaps via telehealth visits and try to come up with new approaches to engage patients in their care. Performance did slip. Some were more challenging than others. Some services were shut down. You know, screenings became harder. But in 2021, we saw a good uptick in many of those measures. So, the good work continued across practices despite all those challenges.

Mike: Wow. So despite that major impact that the pandemic had and all those parameters that you stated, beyond that, what single factor do you think had the biggest impact on our success, on our performance?

Jen: Our single greatest impact was clinical documentation. So you've heard us say that our three priorities are always improving quality, managing utilization, right care, right time, right place, and accurately documenting clinical conditions. And that's important because our financial targets are reflective of our population. So we want it to reflect the acuity of the population and really be able to manage within a budget that reflects that. In 2019, the work that teams did to document that coding impacted our 2020 contracts, at least in the case of Medicare Advantage and Medicare Shared Savings. For Medicare Shared Savings, 2020 was the first year that we had earned savings since 2013. And by all accounts, it was because of that enhanced clinical documentation. So again, having a target that better reflects our population. So great work by the teams on that.

Julie: That's wonderful. So and there's, you know, there's a lot of great data for us, but it's not all about the numbers, right? What stories can we tell ourselves about this report?

Jen: Yeah. Well, as I said, really great pockets of innovation were happening throughout the system in 2020 and 2021, throughout COVID. One, a couple of them in particular, there was one around early detection of Melanoma and the Maine Medical Partners dermatology practice worked to train primary care providers on the condition and also set up e-consults. They were able to offer 600 e-consults in 2020. 84% of those were done within 72 hours of being requested. So that was really phenomenal. Worth noting that of those visits, only 25% of them required a face-to-face. Those that wanted to come in for services or decrease their wait time because they were able to shift some of those to e-consults that really didn't require a visit. And so those that had more severe conditions could get in more timely. And just the e-consults alone saved $170,000. So that was a really meaningful program that continues today. The other example I would share is in Mount Washington, Valley, the Memorial Hospital, and their primary care physicians, they knew that they were faced with a lot of wait times for primary care. And so they went and they offered they went from 35 open clinic hours to 53 per week. So pretty significant. They offered several ten-hour weekday shifts and four-hour weekend shifts. So they were able to increase their primary care panel by 20%. And we all know how important it is to have a strong connection to primary care. So that was a great effort and really demonstrates that with focus, we can improve access to primary care and make an important difference.

Mike: Wow. That is some impressive work. We continue to be amazed at the breadth and the depth of the work that the ACO does in supporting our mission right across the system. So thanks, Jen. Listeners can see the annual report themselves with their very own eyes right at MHACOannualreport.com. So check it out.

Julie: To help celebrate its 20th anniversary, we've invited leaders from the Access to Care program to reflect on their work and their impact in Maine communities.

Mike: Yes. Joining us here today in the studio are three leaders from that program. And I'm going to allow each of them to introduce themselves first, starting with Carole Zechman.

Carol: Hello. Thanks so much for inviting us. Yes, I am Carol Zechman, senior director of Access to Care at MaineHealth.

Mike: Great. Thank you, Carol. And next, we have Kim Beaudoin. Can you introduce yourself?

Kim: Hi. Kim Beaudoin, director of the coverage team with coverage team members in eight counties throughout the state of Maine and New Hampshire.

Mike: Thank you. Kim and third, Kate Herrick. Tell us about what you do.

Kate: Hi. I'm Kate Herrick. I'm the director of health disparities and access at Maine Medical Center. And I oversee the care partners programs in Lincoln, Waldo, Knox and Cumberland Counties, and the Homeless Health Partners Program, which is part of our MMC/Preble Street learning collaborative in Cumberland County.

Julie: Wow. Well, thank you all for being here, and congratulations on 20 years. That is a remarkable achievement. Let's start off by looking at the Access to Care today. So right now, who do you serve, and what is the scope of the work? How about Carol? Can you fill us in there?

Carol: I sure can. Well, Access to Care has certainly grown and pivoted over the last 20 years to meet the ever-changing demands of our health care landscape. We are constantly vigilant for opportunities to improve access to care for vulnerable populations. And today we have 87 team members that work for eight different programs in 14 office locations, spread over eight counties in Maine and New Hampshire. Our programs primarily serve low-income, vulnerable populations and include our flagship program Care Partners. Med Access, which is a statewide program that helps anyone struggling to pay for prescribed medications. Homeless Health Partners provides case management and medical care coordination for individuals experiencing or at risk of homelessness. The coverage team helps uninsured or underinsured individuals explore eligibility for various Medicaid and health insurance marketplace programs. And many of those team members are based at each of our local health systems and serve both inpatients and outpatients. The complex coverage group works with insured inpatients at Maine Medical Center who are identified as needing intensive assistance based on a catastrophic diagnosis. And the patient assistance line is a resource for all patients and providers to assist individuals who are having trouble accessing basic necessities like food, transportation, housing, and child care. Our Medicare Education Project assists patients transitioning to or with existing Medicare plans in applying for the Medicare savings programs, which can help with Medicare Part B and D premiums and out-of-pocket medical costs. And lastly, our Care Partners Plus program provides enrollment assistance and case management for individuals, primarily asylum seekers with health insurance marketplace plans.

Mike: Wow. That is an incredible scope of work. So let's do this. Looking back, let's go back 20 years ago when this whole big program just got off the ground. What problems were you trying to solve?

Carol: Well, many of you may remember. Back in 1999, the Robert Wood Johnson Foundation issued a major grant initiative entitled Communities in Charge, in response to the Clinton administration's unsuccessful national health care initiative. It was clear at that time that health care reform would need to happen at the state and local levels. The percentage of uninsured in Maine was rising, and MaineHealth recognized that we needed to do more than just enroll individuals in free care. MaineHealth was one of 11 RWJ grant recipients nationally and launched the Care Partners program in three counties Cumberland, Lincoln and Kennebec. The program had three primary components: a volunteer provider network that would ensure that every program enrollee had a primary medical home and access to specialty care services, access to affordable medication, and every care partners enrollee is assigned to a case manager to assist with linkages to community resources and navigating the health care system because we know that many of these individuals are facing a multitude of needs, not just access to health care.

Julie: You work with providers both inside and outside the MaineHealth system. If I'm understanding correctly, could you tell us how they connect with you? Maybe. Kim, could you start us off?

Kim: Sure. Providers refer their patients to us in several ways through passing on our contact information and suggesting that patients contact us either by calling or walking into our local offices to find out what services they may be eligible for and also by being connected to local community resources that meet their needs. We have a system that's set up within our MaineHealth electronic record that drives patients who are uninsured to our work queues. So we can reach out to these patients and connect them to those resources directly, either while they might be in the hospital or as an outpatient. As Carol mentioned, our patient assistance line, it was designed to be that contact to connect patients to local community programs. It can be accessed by calling 1-833-644-3571. And that can be also accessed by patients through their MyChart. So it's a smooth process for them to connect right to our program, right on their own.

Kate: And this is Kate. I would just add that word of mouth is a big referral source for us. Many community organizations with whom we work, and other clients who are connected to our programs, refer their clients or friends, or family to our Access to Care programs. And also for our Care Partners program, specifically if a client is enrolling in our program and is connected with a primary care provider who is not in our volunteer network, we will reach out to that provider or that provider practice to see if they'd be willing to join for that specific patient or possibly other patients.

Mike: Wow. Well, congratulations for 20 years and great success. And thank you to you three and all members of the organization for your tremendous work. And thank you for joining us for the BACON podcast today.

Kim: Thank you.

Carol: Thank you.

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

Mike: And we will put contact information for Care Partners on the web page for this episode. Bacon is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us. See you next month.

Julie: See you then.