June 25, 2020

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Caravan Health President and CEO Tim Gronniger recently hosted a webinar to discuss how ACO work can help your practice get through the difficult conditions of a pandemic. Tim was joined by Nicole Banister, Vice President, Practice Transformation and Tim Putnam, CEO of Margaret Mary Health (MMH) in Batesville, IN. View the webinar recording here.


Experience of Margaret Mary Health


In mid-March, MMH became an early COVID-19 hotspot before the virus was prevalent in other parts of the Midwest. MMH is a rural critical access hospital and was quickly overwhelmed with COVID-19 patients presenting with acute levels of illness. This took place before the full CDC guidelines for safety and treatment were available and the situation quickly exceeded critical access capacity. In Tim’s words “within a week and a half, we went from 80 percent outpatient and 20 percent inpatient, to 20 percent outpatient and 200 percent inpatient.” The hospital adjusted quickly with outpatient doctors ready to shift to inpatient service and in time, the surge subsided.

MMH has always been focused on meeting the health needs of the community – one of the reasons for joining an ACO several years ago. The ACO gave MMH and its practitioners a large amount of data about patients. They know exactly what’s going on with patient health, including who has been to the doctor and kept up with preventive care. Now that the surge of COVID-19 has abated in their area, providers have a full picture of the health of the patient population, and patient care needs won’t fall through the cracks. This summer, practitioners are catching up with patients and activities that were deferred during the height of COVID-19. The population health data makes this work possible.
 

Federal Policy Response


In response to the pandemic, CMS has changed how ACOs can take on risk. Most notably, ACOs can stay at their 2020 level of risk for 2021, instead of being required to advance to a new level. In addition, COVID-19-related costs will be disregarded in ACO financial calculations, including establishing benchmarks. For the duration of the public health emergency, no ACO in a downside risk arrangement will be liable for shared losses. CMS could go further in reducing the effects of the pandemic, but these changes, as well as the widespread availability of telehealth and virtual care, will make it easier for ACOs to focus on the emergency.


ACO Model Key to Practice Survival

As MMH experienced this Spring, the benefits of the ACO model of value-based care are especially clear during a pandemic. Most importantly, a population health program adapted to telehealth will deliver a reliable income stream even if patients are not able to come to the office or if it is safer and healthier for them not to do so. Detailed claims data inform providers which patients are high priority for follow-up and clinical interventions. By acting on the information provided by the data, providers can lessen the chance of a secondary wave of intense health need due to deferred care.  

 
Providers have seen dramatic drops in outpatient volume and revenue in all parts of the country. The decline of up to 45 to 65 percent started in mid-March. The Medicare population of age 65+ was not spared from these reductions in visits. Providers are now using population health services and telehealth to turn the decreases in service volume around and get patients the care they need.


Chronic care management can be a critical service to the many Medicare patients with more than one chronic condition. This becomes critical during the pandemic when 82 percent of COVID-19 deaths involve a chronic condition such as hypertension and diabetes. One facility in Louisiana proactively contacted chronic care management (CCM) patients early in the pandemic to establish contact with the care team and answer questions, such as how to get medications without leaving home. This early outreach was a great success, and the facility had no emergency visits or hospital admissions among this population.

Providers at a critical access hospital in Mississippi identified which patients could potentially benefit from CCM during the pandemic. They reached out to patients immediately and doubled the size of their CCM program from an enrollment of 400 patients to 800. With these patients identified and enrolled, their next steps were to screen for depression in order to identify, assess and behavioral health concerns that may be exacerbated by the stress and financial strain of the pandemic.
 

What’s Next in Value-Based Payment


The future of the COVID-19 pandemic remains unclear. What we do know is that CMS is holding strong to its promise to move away from a fee-for-volume reimbursement system. CMS Administrator Seema Verma was recently quoted saying that "CMS has been doubling down across-the-board to encourage the move to value-based care." Caravan’s case studies demonstrate that a provider’s best protection against a second wave of the pandemic is to successfully make the leap into value-based care model.

Although CMS has delayed this year’s application period for the Medicare Shared Savings Program, there’s still a chance to join a Track 1 ACO starting in January 2021. Caravan Health is now accepting applicants for current and non-ACO participants to move into its collaborative ACO model. This approach allows interested participants to be a part of an established ACO with a history of success risk-free. Those interested will need to move fast – the deadline to apply is approaching quickly.

Please reach out to a Caravan expert to learn more.
 

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