National Rural ACO

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Caravan Health Announces Registration for the Accountable Care Symposium

Registration is now open for the Caravan Health Accountable Care Symposium, December 6 and 7, 2017 in Phoenix, Arizona.

The Accountable Care Symposium will build upon last year’s remarkable event, where more than 700 leaders from dozens of ACOs across the country convened to share best practices and learn about new population health programs. The two-day event brings together health care leaders, executives and physicians to explore the complex challenges of value-based transformation. Nationally recognized subject matter experts will discuss and share key strategies to help practices thrive under Accountable Care Organizations (ACOs), Comprehensive Primary Care Plus (CPC+), the Transforming Clinical Practice Initiative (TCPi) and the Quality Payment Program (MACRA). The meeting will focus on real world experience and practical information.

“Caravan Health is committed to empowering clinicians to succeed under Advanced Payment Models,” stated Lynn Barr, CEO of Caravan Health. “The symposium will give doctors and hospitals the operational framework and resources required to achieve outstanding results for their patients while earning recognition and rewards for their efforts.”

Caravan Health’s Accountable Care Symposium will dive deep into evidence-based solutions for topics  including: Advancing Care Information, Behavioral Health Integration, MACRA, healthcare reform and physician engagement. There will be specialized tracks for current and future ACO, CPC+ and TCPI participants.

Registration is now open to the public and is available through the Caravan Health website www.caravanhealth.com/symposium.  Attendees may take advantage of early bird pricing if they register by August 31, 2017. Early bird rates are $199 for current participants of Caravan Health and the National Rural Accountable Care Consortium; $399 for non-participants. Registration rates after August 31 are $299 for participants of Caravan Health and the National Rural Accountable Care Consortium; $599 for non-participants. The program includes an awards ceremony and dinner, two breakfasts and lunches, speakers, break-out sessions, networking meetings, and access to the Pointe Hilton Squaw Peak Resort’s world class amenities.

Community Hospitals Thrive Under ACO Model

Introduction

Caravan Health currently supports 164 community hospitals in Accountable Care Organizations, ranging from $10 million to $1 billion in annual revenue. A common fear of hospital leadership is that ACO participation will result in fewer inpatient stays, lower revenue and lower profitability. While Caravan Health supported ACOs have reduced hospitalizations substantially, accountable care also drives more local utilization and market share, outweighing the negative effects, which results in overall improved financial health. Cost report data of Caravan Health supported 2014 and 2015 ACO hospital participants was analyzed to determine the impact of ACO participation on gross inpatient revenue, gross outpatient revenue and net patient revenue.

Assuming ACO adopters might be different from other hospitals, cost report data for 2016 participants who reported on the calendar year was used as a control group (n=40) to compare 2014 (n=5) and 2015 (n=18) revenue growth for similar hospitals prior to their entering the program.  Average revenue increases and average growth rates between the groups were compared, indicating the percentage of hospitals who had suffered a loss of net patient revenue in each group. Although the data is preliminary, it supports anecdotal information and is consistent across all metrics. Also, as the program became more robust, an increase in positive effects was seen for the 2015 starts (defined as new ACO participants) in comparison to 2014 starts. Preliminary 2016 data (not shown) continues to support these observed trends.

Results

ACO participants were less likely to suffer a net loss in patient revenue compared to the control group. Comparing 2015 revenue to 2013 revenue, none of the 2014 ACOs saw a decline in net revenue compared to 8% of controls. Only 3 out of 18 2015 ACO starts saw a decline in net revenue, compared to 10 out of 40 controls, as shown in Table 1.

TABLE 1

ACO Hospital Impact 2014 Starts
(2015 vs. 2013)
2014 Controls
(2015 vs. 2013)
2015 Starts
(2015 vs. 2014)
2015 Controls
(2015 vs. 2014)
% Hospitals with Net Loss Compared to Baseline Year 0% 8% 11% 25%

 

2014 starts saw a gross inpatient revenue increase of 7% vs. a 9% increase in the controls. Outpatient revenue increased by 1%, but net patient revenue increased 17% vs. 11% for the control group as shown in Table 2. This may be a result of ACO efforts to improve coding and documentation needed for quality reporting, as well as a shift to more profitable outpatient services.

TABLE 2

ACO Hospital Impact 2014 Starts
(2015 vs. 2013)
2014 Controls
(2015 vs. 2013)
2015 Starts
(2015 vs. 2014)
2015 Controls
(2015 vs. 2014)
Average Gross Inpatient % Increase 7% 9% 27% 10%
Average Gross Outpatient % Increase 17% 16% 20% 6%
Average Net % Increase 17% 11% 28% 6%

 

Community hospitals tend to have revenue that ranges from a 50/50 split of inpatient and outpatient to 20% inpatient and 80% outpatient. The ACOs’ focus on prevention, wellness and chronic care management drives increased utilization of outpatient services and decreased occurrence of preventable inpatient stays. Corresponding to higher percentage increases of hospital revenue, higher average dollar increases we seen as well, as shown in Table 3. This data may be difficult to interpret, given that the control hospitals were not the same size as the ACO hospitals. Even so, the increased revenue corresponds with the percentage increases found in Table 2.

TABLE 3

ACO Hospital Impact 2014 Starts
(2015 vs. 2013)
2014 Controls
(2015 vs. 2013)
2015 Starts
(2015 vs. 2014)
2015 Controls
(2015 vs. 2014)
Average Gross Inpatient $ Increase  $3,105,291  $692,457  $2,660,407  $673,880
Average Gross Outpatient $ Increase  $18,347,360  $7,590,309  $21,247,675  $3,581,609
Average Net $ Increase  $12,465,542  $3,113,099  $8,517,275  $3,113,099

Discussion and Limitations

The control group for this analysis, Caravan Health supported 2016 ACO starts, were applicants for the ACO Investment Model program which precluded hospitals greater than 100 beds. This is a similar sized group as the Caravan Health supported 2014 ACO applicants, but the Caravan Health supported 2015 applicants included many larger hospitals that are not easily compared to the 2016 control group. Nevertheless, there is no evidence of declining revenue in any of the ACO participant years, and there Is substantial evidence of increased revenue and growth. This supports the observations and anecdotal reports received from hospital CEOs and CFOs, and may contribute to the low program attrition rate, which is significantly lower than the national ACO average attrition rate.

Download the white paper here.

The Importance of Care Coordination Beyond Cost Containment, and the Use of Health Analytics to Reach the Magic Quadrant

Care coordination has been successful in many cases where applied in U.S. health care, but direct association with cost containment is not necessarily one of them. Care coordination is frequently associated to cost containment, especially when discussing advanced payment models and shared savings, but the two should be considered separately, and on their own merits: care coordination is in pursuit of enhanced patient care, while cost containment is best associated with reduced spending on care opportunities. Cost containment is essentially juxtaposed to care coordination as cost containment must imply reducing provisioning of services, while care coordination increases them.

The takeaway here is not that either care coordination or cost containment should be pursued, but that both are important in achieving better patient care and lowering operating costs for your practice. In many cases, especially for rural practices, the two are related and symbiotic. In theory, cost containment can be achieved by redirecting patient services to less costly services with equivalent outcomes: reducing emergency room (ER) visits is an excellent example where patients can receive better care from visiting their primary care physician (PCP) than from visiting the ER for many situations. Effecting such a change may be difficult or impossible without the use of care coordination. The PCP may simply be too busy providing “primary care” to instill the importance of the change to those high cost patients. Having care coordination in place is where the two concepts converge, entering that magic quadrant of better patient care and lower cost of care.

Care coordination is often associated with lower costs in the romantic conversation of doing more for our patients will lead to lower costs. Economically, such an equation is impossible. But care coordination is not strictly an economic equation, it is at its foundation, a response to populations that need a higher level of care to thrive. Responding to that need is in the highest and best interest of the patient. Unfortunately, the reality of most practices does boil down to an economic equation, and for these practices the word “triage” is a familiar term. Enter health analytics and informatics. Use of advanced analytic tools such as Lightbeam Health is one of the fastest ways to reach the magic quadrant. Care coordinators are put to their best use by addressing the patients that need care the most, and simultaneously reducing the cost of care by effectively rerouting the most expensive patients to high value care opportunities and away from wasteful spending.

Is your practice engaged in care coordination? Are your care coordinators making the best use of their time and your dollars by reaching the highest cost patients who need the most care? Engage with Caravan Health’s clinical practice leadership to find out what you can do to increase your practice’s effectiveness of care.

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Contact information:
James Foster
IS Supervisor
Caravan Health

References:
McWilliams, J., Cost Containment and the Tale of Care Coordination, 2016, New England Journal of Medicine, 275, pp 2218-2220

Impact of Successful ACO Participation on Rural Hospitals

Lynn Barr, CEO of Caravan Health, was joined by panelists Lee McCall, CEO of Neshoba Hospital & Nursing Home, & Don Wee, CEO of Tri-State Memorial Hospital, as they explored the impact of their 2016 Medicare Shared Savings Program participation as part of the Magnolia-Evergreen ACO. Mr. McCall and Mr. Wee discuss how their ACO appeared to save Medicare almost $11 million, including reduced inpatient utilization by 17.7%. Watch the full presentation below.

Impact of Successful ACO Participation on Rural Hospitals

 

Caravan Health Extends Deadline for 2018 ACO Participation to April 30, 2017

April 19, 2017 – Kansas City, MO – Providers who want to take advantage of value-based reimbursements and avoid MACRA penalties in 2018 must act fast – Caravan Health, the market leader in Accountable Care Organizations (ACOs), has extended its deadline for consideration in a 2018 ACO to April 30, 2017.

Caravan Health urges providers to visit their website – caravanhealth.com/apply/ – and fill out a non-binding letter of interest (LOI) to begin the ACO process. Once providers submit an LOI, they will have until June 30 to complete the application process.

“Filling out the non-binding LOI is the first step in transitioning away from volume to value-based care,” says Lynn Barr, MPH, CEO of Caravan Health. “Caravan Health has a 100% application success rate and our expert team will provide guidance every step of the way.”

Ms. Barr states that 124 providers have submitted LOIs to Caravan Health this year and expects up to 200 by the April deadline.

“Our data shows ACO participation is the best option for transforming primary care, increasing revenue and earning MACRA bonuses,” says Barr. “Providers are realizing that they can’t risk waiting another year – the time to join an ACO is now.”

Caravan Health is holding an informational webinar the next two weeks to provide an easy to follow roadmap and address pressing questions. The webinar will take place Friday, April 21 and Friday, April 28 at 8:30 a.m. PT/10:30 a.m. CT/11:30 a.m. ET.  Participants may register at caravanhealth.com/upcoming-events/.

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About Caravan Health
Caravan Health helps providers implement population health programs with affordable, end-to-end solutions that achieve outstanding results. More information regarding Caravan Health can be found on our website at www.caravanhealth.com or email info@caravanhealth.com.

ACO Participation Can Increase MACRA Performance Scores by Thirty Percent

Kansas City, MO – March 29, 2017 – With the first performance year for the new Merit-Based Incentive Payment System (MIPS) underway, eligible clinicians must strategize payment implications under the program. Unlike the Physicians Quality Reporting System, Meaningful Use and the Value-Based Modifier, MIPS places the performance of each clinician on a curve, and adjusts payments based on their precise location in the distribution compared to others.

Lynn Barr, MPH, CEO of Caravan Health, and LeeAnn Hastings, JD, MPH, Compliance Officer for 23 Medicare Shared Savings Program ACOs, have released an issue brief, Impact of ACOs on MIPS Payments for All Eligible Clinicians, comparing MIPS payment adjustments of ACO participants versus non-ACO participants. The brief illustrates that Medicare Shared Savings Program (MSSP) participation will enhance MIPS performance and increase the likelihood of receiving the exceptional performance bonuses. Exceptional performance bonuses are only available the first five years of MIPS and, depending upon the number of exceptional performers, could receive up to ten percent in addition to the maximum positive payment adjustment, which is up to three times the penalty for the first five years of the program. Taking into account CMS’s scaling factor and the exceptional performance bonus, a top-performing practice could theoretically earn up to a 25% payment adjustment in the 2018 performance year.

According to Ms. Hastings, “MACRA requires that 30% of the MIPS score is based on Resource Utilization. Track 1 ACO participants, however, are held accountable for cost in their ACO and not MIPS. As a result, Track 1 ACO participants can more easily achieve high scores compared to other MIPS participants, increasing the likelihood of avoiding MIPS penalties and earning the exceptional performance bonus.”

To predict MIPS bonuses, Barr emphasizes that clinicians must know both their performance score and estimate the score of the rest of the providers in the MIPS pool. Up to 40% of eligible clinicians in the pool are expected to be participants in Track 1 Medicare Shared Savings Program ACOs. Those ACOs will receive special scoring causing most other MIPS-eligible clinicians to receive lower adjustments in comparison.

Barr states, “Small practices should consider joining an ACO to avoid penalties for generally lower scores due to lack of infrastructure, and providers in rural areas may want to join ACOs to avoid MIPS penalties due to their higher cost structures. Community hospitals can earn high bonuses and support their community physicians, particularly specialists, by enrolling them in their ACO, protecting their incomes and reducing their administrative burden.”

Caravan Health, who currently supports 160 community hospitals and 250 practices in 23 Medicare Shared Savings Program ACOs, is holding weekly webinars to help providers navigate the ACO process and fully understand how to maximize their incentive payments. Participants will receive step-by-step financial guidance on how to calculate potential penalties and bonuses under MACRA.

Webinars are held on Fridays at 8:30am PT/10:30am CT/11:30am ET. To register, visit www.caravanhealth.com/upcomingevents.

The full brief, Impact of ACOs on MIPS Payments for All Eligible Clinicians, is available for download at www.caravanhealth.com/macra.

About Caravan Health:
Caravan Health helps providers implement population health programs with affordable, end-to-end solutions that achieve outstanding results. More information regarding Caravan Health can be found on our website at www.caravanhealth.com or email info@caravanhealth.com.

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Media Contact:
Sage Beard
Marketing Manager, Caravan Health
sbeard@caravanhealth.com | 916.542.4564

New Administration Sends Positive Smoke Signals About Value-Based Payments

Last week, the CMS announced a delay in publishing the final rules regarding the new mandatory cardiac and joint bundled payment programs. Significantly, the CMS did not dethe start dates of those programs, put them on hold, or cancel them all together. The new bundled payment programs will begin as scheduled, but the new administration will have a chance to make minor tweaks prior to the July 1 start date.

In spite of Secretary Price’s previous objections to mandatory CMMI programs, the green light from CMS foreshadows a continued commitment to value-based payments. A strong case can be made that the delivery system reforms instituted under the Affordable Care Act are a unique example of successful government intervention. There is compelling evidence to show that these programs have improved the quality of care for millions of people, saved hundreds of thousands of lives, and reduced spending by billions of dollars.

The pressure to reform will continue. Every provider needs to engage in value-based payment models today and begin the learning process. Currently, 30% of providers are engaged in value-based models. Provider engagement is expected to increase to 50% by 2018.  Now is the time to move forward or risk falling behind half the providers in America.

Several companies offer low-cost, supported participation in the Medicare Shared Savings Program for the third of physician groups who do not have 5,000 Medicare lives on their own. These companies include Collaborative Health Systems, Aledade, and Caravan Health.

Applications for 2018 are due to CMS on July 31st, with CMS letters of intent due by May 1st. Please reach out to us at info@caravanhealth.com if you would like to learn more.

 

 

Accountable Care Symposium to Focus on Collaborative Care Agreements and Behavioral Health Integration


Join hundreds of accountable care pioneers to learn how rural and urban hospitals, clinics, small practices and independent providers can achieve better outcomes and higher earnings.

Austin, Texas – December 05, 2016 – The Caravan Health two-day Accountable Care Symposium, to be held January 11 and 12, 2017 at The Pointe Hilton Tapatio Cliffs in Phoenix, Arizona, will provide hands-on training for ACO’s, CPC+ participants and forward thinking primary care practices that want to learn simple techniques that improve care, lower cost and help practices earn significant bonuses under MACRA.

The Caravan Health Accountable Care Symposium will teach tried and true methods for implementing Comprehensive Primary Care (CPC+) Programs, Accountable Care Organizations (ACO’s) and new, billable primary care services. In addition to focusing on a variety of key topics in population health, the Symposium will teach practical processes to address behavioral health issues including the following:

  • How to implement the new Psychiatric Collaborative Care model to integrate behavioral health into primary care practices using nursing staff and remote coaching from Psychiatrists.
  • How to bill for new behavioral health codes
  • Evidence-based tools for psychosocial assessments.
  • How your nurse can use SBIRT for smoking cessation, obesity, and substance abuse.
  • Provide analysis of your referral network based on public use files and claims data to identify the best places to send patients for specialty care.

In addition, the Symposium will provide a workshop promoting better collaboration between primary care, specialty care, and facility care, including the following:

  • How to use collaborative care agreements and regular meetings with specialists to review patient-specific panels.
  • How to collaborate with high-volume Hospitals and Emergency Departments to get notified of patient visits and discharges
  • How to track and compare patient discharges to patients who are contacted for follow-up for continuous improvements.

“Integrating behavioral and mental health services into primary care practices will provide tremendous benefits to the patients we serve, reducing depression, substance abuse and other issues that compromise our patient’s quality of life.” stated Lynn Barr, CEO of Caravan Health. “CMS has introduced these new programs in the 2017 Physician Fee Schedule, rewarding providers for comprehensive, coordinated care.”

The first day of the symposium will be dedicated to policy: explaining the interaction between MACRA and advanced payment models and showcasing real world experiences from pioneers of accountable care and practice transformation. The second day will feature hands-on workshops that will provide instruction on how to simply and affordably implement chronic care management and behavioral health interventions, in addition to wellness, risk adjustment and stratification programs. A special workshop will be dedicated to MACRA’s new Advancing Care Information category, providing practical tips on how to implement the workflows that will achieve the highest scores.

Participants that are currently enrolled in the Caravan Health ACO or CPC+ programs or are participating in any Practice Transformation Network may attend the Symposium at no cost if they register by December 15, 2016. A complete agenda and registration are available through the Caravan Health website www.CaravanHealth.com.

Accountable Care Symposium to Focus on Emergency Department and Inpatient Transitions of Care

Austin, Texas – November 29, 2016 – The Caravan Health two-day Accountable Care Symposium on January 11 and 12, 2017 at The Pointe Hilton Tapatio Cliffs in Phoenix, Arizona, will provide hands-on training for ACO’s, CPC+ participants and forward-thinking primary care practices that want to learn simple techniques that improve care, lower cost and help practices earn significant bonuses under MACRA.

The Caravan Health Accountable Care Symposium will teach proven methods for implementing Comprehensive Primary Care (CPC+) Programs, Accountable Care Organizations (ACO’s) and new, billable primary care services. In addition to focusing on a variety of key topics in population health, the Symposium will teach emergency department and inpatient follow up procedures. Hands-on workshops will provide key materials and training to help attendees to strengthen their skills and gain confidence carrying out these processes.

  • Receive scripts, tools and training to approach high volume hospitals and emergency departments to develop notification processes upon discharge.
  • Receive training on protocols for scheduling post-discharge follow-up with your nurse.
  • Learn how to bill for Transitional Care Management Services.

“Our patients are highly vulnerable during these transitions from the hospital and emergency department settings.” stated Lynn Barr, CEO of Caravan Health. “This program will help our practices help our patients when they need it the most.”

The first day of the symposium will be dedicated to policy: explaining the interaction between MACRA and advanced payment models and showcasing real world experiences from pioneers of accountable care and practice transformation. The second day will feature hands-on workshops that will provide instruction on how to simply and affordably implement chronic care management and behavioral health interventions, in addition to wellness, risk adjustment and stratification programs. A special workshop will be dedicated to MACRA’s new Advancing Care Information category, providing practical tips on how to implement the workflows that will achieve the highest scores.

Participants that are currently enrolled in the Caravan Health ACO or CPC+ programs or are participating in any Practice Transformation Network may attend the Symposium at no cost if they register by December 15, 2016. A complete agenda and registration are available through the Caravan Health website www.CaravanHealth.com.

About Caravan Health:
Caravan Health helps providers implement population health programs with affordable, end-to-end solutions that achieve outstanding results.

 

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CONTACT:
Bryan Hagar
Communications Director
Caravan Health
916 542 4583
bhagar@caravanhealth.com

Care Coordination to be Featured at the Caravan Health Accountable Care Symposium

Join hundreds of accountable care pioneers to learn how rural hospitals, clinics, small practices and independent providers can achieve better outcomes and higher earnings.

Austin, Texas – November 21, 2016 – The Caravan Health two-day Accountable Care Symposium, to be held January 11 and 12, 2017 at The Pointe Hilton Tapatio Cliffs in Phoenix, Arizona, will provide hands-on training for ACO’s, CPC+ participants and forward thinking primary care practices that want to learn simple techniques that improve care, lower cost and help practices earn significant bonuses under MACRA.

In addition to covering a number of other prominent topics in population health, the Symposium will help participants learn tried and true methods for implementing CPC+, Accountable Care Organizations, and new, billable primary care services. Hands-on workshops will help practices set up the following programs

  • Chronic Care Management
  • Transitional Care Management
  • Risk stratification
  • Empanelment

Participants can meet and network with experienced care coordinators who have already implemented these programs successfully in hospitals, rural health clinics, Federally Qualified Health Centers and primary care practices.

“Care coordinators are the heart and soul of population health. These workshops will teach practices how to set up successful care coordination programs that improve outcomes and are financially sustainable.” stated Lynn Barr, CEO of Caravan Health.

The first day of the symposium will be dedicated to policy: explaining the interaction between MACRA and advanced payment models and showcasing real world experiences from pioneers of accountable care and practice transformation. The second day will feature hands-on workshops that will provide instruction on how to simply and affordably implement chronic care management and behavioral health interventions, in addition to wellness, risk adjustment and stratification programs. A special workshop will be dedicated to MACRA’s new Advancing Care Information category, providing practical tips on how to implement the workflows that will achieve the highest scores.

Participants that are currently enrolled in the Caravan Health ACO or CPC+ programs or are participating in a Practice Transformation Network may attend the Symposium at no cost if they register by December 15, 2016. A complete agenda and registration are available through the Caravan Health website www.CaravanHealth.com.

About Caravan Health:
Caravan Health helps providers implement population health programs with affordable, end-to-end solutions that achieve outstanding results.

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CONTACT:
Bryan Hagar
Communications Director
Caravan Health
916 542 4583
bhagar@caravanhealth.com