October 2021 Newsletter

Contract & Network Update

Adirondacks ACO 2020 Performance Results in Shared Savings

The ACO Board of Managers is pleased to announce the approval and distribution of shared savings for performance year 2020.  Performance year 2020 is the first time since the development of the ACO in 2014 that a Medicare Shared Savings (MSSP) distribution will occur.  The first installment of this distribution plan will include over $3.7 million dollars that is being shared with our participating provider partner organizations. This represents 98% of the savings earned with the 2% balance utilized to offset participant fees that support the ACO infrastructure.

As additional payer contract settlements are finalized and funds are received, a second distribution installment is expected to be made in early 2022.

Thank for your continued efforts and dedication to our population health efforts in the region.  Despite the impact of the on-going response to the pandemic, the ACO’s overall quality was higher than prior performance years and our financial performance resulted in the highest amount of shared savings for distribution in our 7 year history.

 

COVID-19 Booster FAQs

Confused about all the news on boosters? You are not alone. Here are some answers to your questions.

Why is it so confusing?
There are 3 vaccines that either work differently or are dosed differently. And there are others approved by the WHO.  As a strategy to develop vaccines rapidly,  this made perfect sense by increasing the chance that at least some vaccines would work. It does add to confusion now as they all have differences in how long they protect after “full vaccination.”

Can we make it simple and just say everyone should get a booster at a certain time, regardless of vaccine?
Our vaccines are very safe, but there are rare toxicities that are outweighed by the benefits of vaccination. But, if we give unneeded boosters, then risks might outweigh benefits. Also, from a global perspective, it is unethical to use vaccine unnecessarily. So, the decision is made for each vaccine on its specific data.

I received the Pfizer vaccine (Comirnaty). Do I need a booster, and if so, when?
No one should receive a booster unless it has been six months since your second dose. If you are over 65, or over 50 with a chronic medical condition, you should receive a booster. If you are over 18, have a chronic medical condition, or either work or live in a high-risk environment, you may receive a booster, but you are still VERY well protected without a booster. Healthcare is considered a high-risk environment.

I received the Moderna vaccine (Spikevax). Do I need a booster, and if so, when?
Although Moderna immunity may be a bit more durable than Pfizer in protecting against hospitalization, Moderna has requested approval of a half-dose booster to the FDA. If approved, it will probably be similar to the Pfizer recommendations.  It seems this may happen later this month.

I received the Johnson and Johnson vaccine. Do I need a booster, and if so, when?
J&J has submitted data to the FDA asking for approval of a booster dose. Interestingly, the J&J vaccine activity does not seem to wane with time. But, one dose of J&J is not as effective against symptomatic infection as the mRNA vaccines, even after mRNA vaccines have waned over time. A J&J press release claims that after a booster, it is 94% effective against infection and 100% effective against severe disease. It seems like this should have been a two-dose vaccine, to begin with.  FDA action is expected over the next month or two.

I am eligible for a Pfizer booster. Where can I get it?  
Go to the federal website. Find COVID-19 vaccines. This will show the many pharmacies and local health departments, which vaccines they have, and how to schedule.

 

 

Wouter J. Rietsema, M.D.
Adirondacks ACO Chief Medical Officer

The North Country Care Coordination Collaborative (NCCCC)

The North Country Care Coordination Collaborative (NCCCC) training sub-group developed a Care Manager Training survey to help develop a training toolkit.  The survey contained eight questions, including what type of care management agency they worked for.  The choices were Inpatient, Primary Care, SUD/BH, or an agency not affiliated with a hospital or provider. The survey asked what the most challenging task or responsibility in their job was.  To prioritize workforce development, the survey asked respondents to rank in order of importance training topics.  There was also a free text option to indicate any issues not listed. The top three responses were:

  1. Burnout Management
  2. Sharing your “bag of tricks” for dealing with difficult patients/situations
  3. Vicarious Trauma and Self Care Strategies

The survey then asked what “bag of tricks” items would interest them in a brainstorming session, including a free text option for topics not listed.  The top three responses were:

  1. How do I best support a difficult client or family?
  2. Exploring the boundaries for Care Coordination vs. Care Delivery
  3. Strategies to responding to anger or Client frustration

The final question was a free text opportunity to inform the sub-group of anything else they felt would enhance workforce development. 
The NCCCC was pleased to have 138 respondents to the survey.  The results were collated, and the subgroup is meeting regularly to create a toolkit to include: An inventory of available training, an inventory of available regional services, and a forum to share best practices on specific topics.

 

Adirondacks ACO Fall Provider Meeting

Date: Wednesday, October 27, 2021
Time: 5:30 p.m.
Where: Virtual Meeting

Despite the unprecedented events of 2020, Adirondacks ACO’s network of providers continued providing high quality care. We improved many quality indicators and realized shared savings in most contracts including Medicare for the first time. Join us at the fall Provider meeting to review our 2020 performance and get feedback from you on how we can support your work.

For more information contact Meg Henning

Quality & Performance Update

2022 MIPS Payment Adjustment

The Merit-based Incentive Payment System (MIPS), was designed to tie payments to quality and cost efficient care, improve care processes and health outcomes, increase use of healthcare information and reduce the cost of care.  CMS has established criteria to determine whether providers are considered eligible clinicians, based on claims during the measurement year. CMS adjusts eligible clinicians’ pay based on how they “score” in four categories of metrics: Quality, Cost, Improvement Activities, and Promoting interoperability.  The ACO submits the Quality component on behalf of the providers that practiced during the measurement year 2020 via the manual data abstraction and submission to CMS via their web interface. The categories of Cost and Improvement Activities the ACO receives auto credit for, since the providers are part of the ACO.  Promoting interoperability must be reported by the practices to CMS directly, which focuses on electronic prescribing, health information exchange, provider to patient exchange and public health and clinical data exchange.  The ACO receives an overall score based on the provider submissions.  Below is the ADK ACO MIPS Performance Score.

All Final Scores between 85 and 100 points will receive a Positive Payment Adjustment, on a linear sliding scale and be multiplied by a scaling factor to preserve budget neutrality and will be eligible for an additional adjustment for exceptional performance.  So the max that could have been earned is 9% but to maintain the budget neutrality we are at 1.87%

ACO Spotlight

Each year across the Unites States, advocates come together during October, Domestic Violence Awareness Month (DVAM), to speak up about domestic violence, raise awareness, and support survivors of this all too common issue in our world. Evolved from an event arranged by the National Coalition Against Domestic Violence in 1981 called the Day of Unity, the first full month-long awareness month took place in 1987, the same year that the 1st national domestic violence toll-free hotline was created. Many of the events that typically take place during this month focus on mourning the victims who are no longer with us due to domestic violence, celebrating the lives of those who have survived, connecting those who work to end violence in our communities, and working to have an impact on the systems in control so that those responsible for domestic violence, the abusive partners, are held accountable for their actions. DVAM is so important in the advocacy world because we know that providing support alone will not end the violence, there must be education throughout the community to dispel myths and stereotypes, and accountability for crimes committed.

At STOP Domestic Violence, we have had the honor of serving survivors of domestic violence in the North Country since 1977. Since our beginnings we have grown from a small one staff, one room office, to a team of 15 staff members spanning across the North Country, providing residential and non-residential services to hundreds of survivors each year. STOP Domestic Violence is a New York State certified program that provides services and support to victims of domestic violence and their children. We can inform victims of their rights, assist in the exploration of options, and support those in need in the decision making process. Services include, but are not limited to: crisis intervention, emergency housing, supportive counseling, advocacy with law enforcement, the courts, Child Protective Services, the Department of Social Services, etc., child care during essential appointments, community education about the dynamics of domestic violence and the influence it has on society, transportation to and from essential appointments, support group for survivors of domestic violence, and assistance in filing for compensation from the New York State Office of Victim Services. We also operate and maintain a 24-Hour hotline with trained volunteers and staff who listen without judgement and help with safety planning. We have offices located in Malone, Plattsburgh, and Westport, New York, serving Clinton, Essex, and Franklin County domestic violence survivors and their children as well as all victims of crime.

If you would like to celebrate DVAM with us, please contact us at 518-563-6904 or email us at stopdv@bhsn.org and we will make sure that you have informational brochures, pamphlets, and posters for your agency or business, as well as purple ribbons to wear throughout the month of October to show your support to survivors of domestic violence in the North Country.

 

Resources

ADKs ACO and Highmark BS Collaboration Webinar: HEDIS 2022 Updates

Date: November 17, 2021
Time: 12:15 P.M. – 1:00 P.M
For more information contact Brenda Stiles

Excellus BlueCross ClueShield 2021 Fall Seminar Schedule

Join the Excellus BlueCross BlueShield Provider Relations team virtually for the 2021 fall seminar. You’ll gain valuable information on the latest administrative and operational updates, industry news, what’s new for 2022 and more!

Visit Provider.ExcellusBCBS.com/resources/management/staff-training to register for one of the following sessions:

November 3, 2021
▪ 9:00 – 11:00 AM
▪ 1:00 – 3:00 PM

November 4, 2021
▪ 9:00 – 11:00 AM
▪ 1:00 – 3:00 PM

November 9, 2021
▪ 9:00 – 11:00 AM
▪ 1:00 – 3:00 PM

November 10, 2021
▪ 9:00 – 11:00 AM
▪ 1:00 – 3:00 PM

 

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