Before we go into the details of what we are doing, it is important to clarify what we are NOT:
• An HMO or PPO-style network
• A Buying Group
• Taking our clinics and enrolling them in programs that are already available
In January 2013, Arkansas High Performance Network launched a pilot program through the Centers for Medicare and Medicaid Innovation. Made up exclusively of independent primary care, we launched with an initial group of over 100 providers.
After undergoing a highly competitive selection process by CMMI in the fall of 2012, our application was approved for participation in the 2013 Medicare Shared Savings Program. In addition, we were one of 35 groups in the country to be chosen as one of the most elite Advance Payment recipients. We received specialized Medicare funding to launch and implement specific resources (at no cost to clinic or patient) targeted to improve patient experiences and population health outcomes.
We have now completed our first performance year of the Medicare Shared Savings Program and had great results, saving approximately $5,300,000 (8% off “spend-trend”).
We are now replicating that success with other payors and additional providers, and showing providers how they can potentially DOUBLE clinic revenue by transitioning their clinic from volume-of-care to value-of-care, without sacrificing their current fee-for-service reimbursements.
We now have over 250 independent PCPs in Arkansas, and anticipate 500-600 before September 2014. By combining the critical mass of providers with our proven results, we can go to payors and create new long-term, profitable, fair pay-for-performance programs that are only available to our network of providers.
Not only do participating clinics have access to new resources and exclusive programs, our business model allows providers and clinics to participate with no out-of-pocket costs or ongoing network fees.
We’ve developed a new model both “fair” and “sustainable” that is a WIN-WIN FOR ALL!
“The Downward Spiral”
In working with and speaking to hundreds of providers across our state, one topic has been brought up almost unanimously – Physician Fatigue! Independent primary care clinics are in an unsustainable cycle of declining reimbursements and increasing expectations, as evidenced by the mass migration of our independent PCPs to the safety and security of hospital systems.
This broken model does not only negatively affect independent primary care providers, but the entire healthcare continuum. For the sake of the healthcare system as a whole, something must be done to change this cycle.
Do not allow yourself to stay in the cycle of overwhelming expectations and stress – good things are coming!
Change is HERE!
We are well on our way pioneering payment reform in Arkansas. As the healthcare system transitions from traditional fee-for-service to value based payments, great opportunities have emerge for those ready to adapt!
As you have seen, more and more, reimbursements are being tied to performance metrics. The good news is, in a pay-for-performance reimbursement model, no one is more influential than independent primary care.
Independent PCPs can and should be in the driver’s seat, and NOW IS THE TIME TO ACT.
We’re not clinicians telling anyone how to practice medicine, we’re business people with proven healthcare results.
As payment reform is creating uncertainty across the healthcare system, our background puts us in perfect position to help lead our providers in the right direction.
Our background is in working with self-funded employer health plans. With many large employers, their overall claims costs are as much as half those of private payors, largely due to the aligned agenda within these organizations.
Self-funded employers are large-employers who do not have an external insurance company. They take in premiums from their employees and pay claims themselves. Because of this, not only is it in their best interest to lower claims costs, but they have the added incentive of preventing sick employees from missing work and not producing. Wellness is KEY!
In 2009, our leadership began working with a coalition of large employers, whose sole purpose was to come together and create strategies that would lower overall claims costs WHILE making their employees healthier. While the rest of the healthcare system was continuing the fee-for-service reimbursement model, we were perfecting the art of pay-for-performance.
We helped this group of employers test and implement multiple strategies, including pioneering an on-site primary care business that cut overall claims cost BY 50% for the patients it managed.
It was for this reason that in building our network for the Medicare Shared Savings Program, we only targeted independent primary care. Independent primary care can impact overall cost unlike any other provider, and now there are programs that provide a significant incentive to do so.
1. Data Analytics
In launching our group, we worked in tandem with developers and providers to build our own proprietary data analytics engine. This engine takes raw claims data directly from participating payors on ALL claims data, not just diagnosis found within practice EMR. We then take that data and identify the highest risk patients and target resources towards them.
In addition, our analytics identify gaps in care, which gives our providers the actionable information they need to better serve their patients.
All this information is available at no out of pocket cost to our providers in a simple, easy-to-use dashboard.
2. Risk Stratification
80/20 RULE – 80% of the total costs come from the sickest 20% of the population
60/5 RULE – 60% of the total costs come from the sickest 5% of the population
Our data analytics identifies the most at-risk patients and what their gaps in care are. By combining that information with our targeted Care Coordination Support, we can show providers how they can grow their bottom-line by over $200k per provider.
3. Care Coordination Support
In addition to the data analytics, we have also built a team of nurses as health coaches who are available at no out of pocket cost to supplement our clinic providers in managing their patients. This allows our providers to “hand-off” (at their discretion) their high-risk patients to a team that will help these patients accomplish their health goals and better follow their PCP’s directives. We have found this to be effective as we further our efforts towards preventative medicine, reducing avoidable hospitalizations and avoidable hospital readmissions.
Resources include: Health Coaches, Case Managers, Process Improvement Specialists, and other support.
In kicking off Performance Year 2 (2014), one of our goals is to partner with local hospitals on information exchange so that all providers have the most updated information. In order to continue driving down claims cost, it is imperative that there is collaboration between our practices and hospitals regarding admitted or discharged patients. We must insure the exchange of accurate and timely information to treat and follow up with our patients as they transition from hospital care back to their primary care provider/medical home.
In addition, we are now the only organization in the state to have a track record of proven results in saving claims dollars. We can use this as a basis for the creation of new opportunities with multiple payors that are both FAIR and SUSTAINABLE for ALL parties, as well as present a business solution for streamlining quality metrics and expectations!
As we move forward, we will continue to test and implement a variety of cost-saving strategies, narrowing our scope as we go to pinpoint programs that bring our organizations the most return on their time and energy.
Exciting Collaboration Opportunity!
The opportunities to increase patient health, improve healthcare outcomes, and decrease overall cost are almost limitless, and we invite and encourage all our providers to collaborate with us on their ideas. By identifying practical, innovative, common-sense strategies and sharing best practices across a statewide network of providers, we can make a huge difference. A high tide raises all ships!
The programs we are creating are a powerful alternative to the rapid consolidation in the healthcare industry. Our growing group of aligned healthcare providers holds enormous appeal for providers who are interested in identifying and employing “best practices” into their clinics and generating diversified revenue streams.
We are excited about sharing our story and vision with you! Please Contact US so that we can tell you more about our successes, and hear about your ideas for achieving better health outcomes!
PROVEN RESULTS: WHAT WE'VE DONE
7.85% – Total Cost Reduction of MSSP FIRST YEAR = $5,300,000 PY1 Cost Savings
(13,000 Medicare Patients / 100 Independent PCPs / 55 Practice Locations Statewide)