Contract & Network Update
On behalf of everyone at Adirondacks ACO, we want to thank all of you at our participating organizations. We are grateful for all of you on the front lines, caring for our families, neighbors, and friends. Despite the extraordinarily difficult circumstances, our community members continue to receive high quality care every day. Warm wishes for safe and happy holidays and a very happy 2021!
Adirondacks ACO has finalized contracts or is in the final stages of negotiations with our payers. This was a particularly complicated year due to the financial and quality performance impact of COVID. Our payers were very flexible, recognizing the value of our network working with us to arrive at reasonable terms. Generally there were only minor changes to most contracts in terms of quality and finance and we improved our position, increasing our care management PMPM with two payers. We will be sending out contract notices for many of the contracts before the end of the year.
The following contracts are in final negotiations or are signed:
- BlueShield of Northeastern NY has agreed to an increase in the PMPM, an increase in the savings and risk potential, and modified their quality gate.
- CDPHP launched a new program last year so there is no change this year.
- Empire has agreed to an increase in the PMPM and a slight increase in risk with significant opportunity for potential increase in savings. They are launching a new primary care incentive program called Reimagining Primary Care. Read about it HERE
- Fidelis has agreed to a continuation of the current shared savings and increased our risk mitigation approach while continuing to support our work with Northwinds Integrated Health Network. Our arrangement for the HARP population remains the same. Our PMPM is dependent on the NYS budget.
- MVP has agreed to a similar contract to last year.
- UnitedHealth Care Empire Plan has agreed to a similar contract with a request to work on a total cost of care approach for 2021.
- Excellus has agreed to improved financial trends and a 2 year deal locking in our PMPM and financial terms.
If you have any contracting questions or want to discuss any of the contracts in detail please email Kelly Lange.
Quality & Performance Update
2020 Data Measure Abstraction
Quality measure data extraction for 2020 will begin the first week of January 2021 and will continue through the middle of February. The data extraction is for both the Medicare Shared Savings Program (MSSP) and the Commercial quality program. The ACO team will contact you to schedule a date for the abstraction, either in person or remotely. Our team will be prepping the sample prior to our arrival to minimize the amount of disruption for you and your patients.
Please submit your practice’s gap closure information to the ADKs ACO team no later than December 21, 2020. Completing the spreadsheet along with the evidence of gap closure is required. In the event the ACO is audited we must have evidence of how the gap was closed. In 2019, the submission of the supplemental data to the ACO increased our overall results significantly in several measures, allowing all practices to share in savings. If you have any questions please reach out to firstname.lastname@example.org , email@example.com or firstname.lastname@example.org.
On December 1st Medicare issued a final rule that aligns the current quality measurement of the Medicare Shared Savings Program (MSSP) with those in the Quality Payment Program (QPP), but giving the ACO’s another year to prepare for this significant shift in reporting. For measurement year (MY) 2020, CMS will automatically give the ACO full credit for the 2020 patient experience surveys.For MY 2021, CMS has extended the use of the CMS Web Interface for quality reporting. ACO’s have two options for reporting quality in 2021:
- CMS Web Interface reporting on 10 clinical quality measures, OR
- Electronically report through vendor platforms approved for MIPS on 3 clinical quality measures
ADKs ACO Quality Improvement Workgroup will be monitoring our progress of over the 2021 performance year to determine which option is the best course of action for our network to submit quality measure performance.
MY 2022, all ACOs will be required to report the 3 clinical quality measures under MIPS. There will only be six quality measures to determine quality performance.
Your feedback is always greatly appreciated, please reach out to email@example.com.
HRSA: Rural Health Care Coordination Program
Health care providers in the Adirondack region of northern New York have participated in a number of collaborative projects and programs over the past decade including the nationally recognized Adirondack Medical Home pilot and the statewide Delivery System Reform Incentive Payment (DSRIP) Program and have developed organizations to sustain their collaborations, to include Adirondacks ACO, Adirondack Health Institute and Northwinds, IPA. Through these successive projects, the region’s health care sectors have developed strong relationships and are now focusing on whole person care and how to improve health and outcomes together.
In July of this year, CVPH on behalf of the North Country providers, was awarded one of ten national HRSA grants to support the further development of a rural health care coordination program. The North Country Care Coordination Collaborative (NCCCC) was established with partners from across the region to include our region’s hospitals, primary care providers, behavioral health and substance use disorder providers, long term care providers, home care providers and Hixny, our regional health information exchange.
This collaborative will be operationally supported by the Adirondacks ACO and AHI, continuing with our ongoing efforts to enhance the foundation for regional care coordination. Our initial efforts will begin with persons being discharged from hospitals in the region and focus on successful transitions of care. The model is being built to ensure that the needs of the population (persons with COPD, CHF, diabetes, and mental health diagnoses) will be efficiently and effectively addressed through standardized tools and integrated communication strategies available to partners across multiple settings, providers (clinical and non-clinical) and communities within the North Country region.
For more information, Click HERE
The eIntervention solution is a unique digital health tool combining a web-based, flexible, closed-loop referral management platform optimized for behavioral health and, Envoy, a smartphone app for individuals and family members.Too often, referrals to treatment and transitions of care related to substance use disorder (SUD) and other behavioral health treatment services have low success rates, typically ~30%, sometimes as low as 8%. Some of the issues that have been identified include challenges for provider coordination and the individual’s fluctuating (sometimes fleeting) readiness for change. Nevertheless, the importance of getting individuals to treatment and keeping them in treatment is too great to be ignored. For this reason, CHESS Health developed eIntervention.
This dynamic solution serves four core purposes:
- Getting more individuals to treatment for substance use disorder (SUD) by bringing closed-loop referral tracking and patient engagement to SBIRT and hospital/ED interventions
- Improving and measuring transitions of care for substance use disorder and mental health services, including provider-to-provider, corrections/justice to community, and social services
- Delivering targeted education, motivation, and support to individuals related to transitions of care, including special populations like pregnant women with opioid use disorder
- Supporting families of individuals with SUD and mental health disorders, delivering education, motivation and support
Reinstating Reimbursement for Preventive Health Visits for Children and Adults via Telehealth During the Public Health Emergency, Click HERE.
New York State Department of Health notification and instructions for healthcare provider practices (outside of the five boroughs of New York City) interested in administering COVID-19 vaccine. Providers must be enrolled in the New York State COVID-19 Vaccination Program to be ready to order and receive publicly supplied COVID-19 vaccine and ancillary supplies. For more information, Click HERE.
An updated MLN Article for FQHCs, New & Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHE and wanted to share with you. If you are interested in receiving MLN weekly email newsletter please reference the MLN Connects webpage.
Webinars & Training’s
Pediatrics for an Equitable Developmental Start (PEDS) Learning Network
Learning Collaborative Series #2
Adverse Childhood Experiences and COVID-19: Community Response
Date: Every Tuesday; Starting January 5th
Time: 10AM– 12noon
Location: Virtual (via ZOOM)
Juliette Lynch, MS. Ed. – Lead Facilitator firstname.lastname@example.org
Please contact us with any questions or to register at: (518) 566-3468.