Caravan Health Founder Lynn Barr hosted a webinar to review the outstanding results from the second year evaluation of the AIM program. Caravan played an important role in AIM, recruiting half of rural participants that earned 60 percent of savings for Medicare. Lynn was joined by two ACO leaders from small, rural, critical access hospitals, Patrick Sustrich, from Hayes Green Beach Memorial Hospital, and Kim Shiner from Schoolcraft Memorial Hospital to let us in on the secrets behind their outstanding performance.   

If you missed the webinar, check out the recording here

AIM is one of the biggest success stories in value-based payment. In its second year, the program reached nearly half a million beneficiaries across 45 ACOs. The rural AIM providers saved Medicare over $300 million over the first two performance years – more than almost any other value-based payment program. Even better, AIM ACOs have earned enough in shared savings to pay back nearly $40 million of the approximately $100 million loaned by CMS. AIM ACOs achieved these amazing financial results without sacrificing care quality.  

This interactive webinar included a robust discussion about how to succeed in a rural ACO. Some of the Q and A highlights are below.  

AIM sounds like a great opportunity – Is it still possible to sign up? 

AIM was a great opportunity for practices to get a boost when jumping into value-based payment. Between 2016 through 2018, CMS provided AIM loans to small ACOs in underserved communities. Small rural practices used the loan funds to invest in the infrastructure necessary to make an ACO work, like new information technology systems. Rural providers made investments in clinical practice, like population health nurses and other staff to run care management programs.  

Unfortunately, it’s not possible to sign up for the AIM program at this time. CMS has indicated that a new model for rural providers will be announced later this year. Caravan Health hopes that this new model builds on the success of AIM and allows even more rural ACOs to flourish with proper financial support.  

Can you offer advice for succeeding on quality measures? 

To be eligible for shared savings, ACOs must perform well on a range of quality measures across domains such as patient experience, care coordination, preventive health, and at-risk populations. These include clinical measures such as the rate of flu vaccines, depression screening, and diabetes blood sugar tests. Overall, AIM ACOs were able to keep up, or even make gains, on these quality measures while saving money for Medicare.  

The hospitals in AIM had quite a bit of good news to share. Hayes Green Beach made strong progress on fall risk screenings, diabetic eye exams, and pneumococcal vaccination rate. Schoolcraft increased the rates of depression screenings, fall risk, and pneumococcal vaccination. Lots of hard work and dedication to practice transformation made these results possible. 

Though the performance overall was strong, the hospital leaders on the webinar also talked a bit about challenges in showing progress on certain clinical measures related to chronic health conditions. Blood sugar levels for diabetic patients and blood pressure levels for hypertensive patients are especially challenging and require a lot of training for providers to get improvement. Making gains on these measures requires provider and patient education, and a commitment to preventive services such as annual wellness visits.  

Some great tips came out of the discussion of the hard work of quality improvement. Both hospital leaders recommended that ACO practices focus on the reasons for doing this population health work (the “why”), rather than counting how many services are performed (the “what”). For example, care management services can be critical in spotting behavioral health issues, such as depression or substance use disorders.  

How does your practice staff new population health positions? What specialty provider staff did you hire?  

Both Schoolcraft and Hayes Green Beach have hired new clinical staff to manage the increase in population health work. For Schoolcraft, this meant bringing a licensed professional counselor on board as a patient navigator. The counselor’s training is a tremendous asset when having difficult conversations around illness. It doesn’t hurt that she has strong interpersonal skills and connections in the community. Both hospitals hired other providers with specific skills, such as an ENT, nurse practitioner, podiatrist, therapist, and orthopedic surgeon.  

In addition to hiring specific clinicians, AIM funds helped these hospitals launch new initiatives, like a community paramedic program that can offer health-related services in the patient’s homes. This kind of clinical innovation is a hallmark of a health system that truly responds to the needs of its population. Another benefit is that new clinical services bring in new quality-focused revenue streams that make rural health care more sustainable.   

For more of our stories about success in rural health care, read our profiles of Clearwater Valley Hospital and Central Oregon Independent Practice Association.  

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