Frederick Regional Health System (FRHS) in Maryland wanted to participate in the Centers for Medicare & Medicaid Services’ Medicare Shared Savings Program (MSSP). To ensure success, it needed a network of community-based primary care and specialty physicians to join with its hospital-owned practices in an accountable care organization (ACO) for Medicare beneficiaries. The application timeline was very tight. The national letter of intent was due in May 2014; final application, the end of August 2014.
To ensure the successful development of an ACO capable of succeeding in the MSSP program, FRHS engaged Premier, Inc. (NASDAQ:PINC) population health consultants in late 2013 to guide development efforts. FRHS also joined Premier’s PACT™ population health collaborative and Medicare Shared Savings Advanced Network. Both are designed to help health systems prepare the MSSP application, prepare to transition to population health and successfully deliver high quality care at a reasonable cost a collaborative way.
According to Jennifer Teeter, assistant vice president, payer contracting and government relations and executive director of the Frederick Integrated Healthcare Network, Premier consultants were onsite throughout 2014 assisting in all aspects of ACO creation. Initially, a detailed work plan was created to guide the year-long effort and physician education sessions were held to educate providers on the importance of population health and why an ACO strategy was needed.
Premier consultants then helped establish and implement the legal ACO entity by:
- engaging external legal counsel to develop core ACO legal documents,
- designing the ACO governance and committee structure and placing physician and FRHS administrative leaders in key roles,
- designing the network incentive structure, which focused on rewarding physicians for population health efforts,
- identifying clinical areas of opportunities to enhance quality and cost savings, and defining performance measures that each participating provider would be held to in Year 1.
Premier also helped identify and onboard employees. Key to successful ACO development was Premier’s ability to balance an accelerated ACO build while navigating the sometimes challenging policy issues associated with the MSSP program.
The most valuable part of engaging the full Premier team was gaining access to others’ experiences, pitfalls and advice, Teeter said. “We learned a tremendous amount attending the PACT conferences and being on the collaborative’s weekly conference call once the MSSP application process began.” The calls involve people nationwide who are going through the process. “You hear from people who’ve been there and get the benefit of their experience to guide us through the process,” she said.
At the 11th hour, Premier’s Advocacy group got FRHS representatives on a conference call with Medicare decision-makers to get a clearer understanding of what was needed in part of the application where confusion could have delayed approval, she said.
Frederick was accepted into the MSSP program beginning January 1, 2015, and is responsible for 10,060 Medicare beneficiaries.
“We implemented our way through that plan in six months and applied to MSSP,” Teeter said. “We have a real success story standing up a clinical integrated network with great local provider participation in very short time,” she continued. “Premier’s expertise helped us engage community physicians and provide a sense of urgency. Eighty-four percent of the primary care physicians in our community are in our network as well as a good contingent of specialists.”