Shelley Janke

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 found that the Medicare Shared Savings Program (MSSP), unlike the Medicare Advantage program, saved Medicare money between 2016 and 2018. But the report’s authors noted that the savings came at a heavy cost––physicians are burned out on the elaborate and time-consuming process of reporting MSSP quality measures to CMS.

That is a big part of the reason why the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA) have asked CMS to reduce the burden of MSSP quality reporting. CMS has committed to reducing the amount of burden on payers and providers, and paring down quality ratings’ overhead is a key part of that.

Coeur d’Alene, Idaho-based ACO Kootenai Care Network (KCN), is using population health and analytics technologies to significantly reduce the burden of quality reporting––combining clinical data from 31 different EHR vendor systems and saving hundreds of hours of clinician labor.

 closed 57% of the quality gaps uncovered-improving the ACO’s quality scores and preventing costly reductions in the ACO’s shared savings rate.

Although the history of Kootenai Health spans more than 60 years, the network (KCN) and Kootenai Accountable Care, its Medicare ACO, are young. KCN formed in 2016, and the ACO was formed in 2017 to join the Medicare Shared Savings Program (MSSP).

One of the gaps for the ACO was its overall lack of experience with the group practice reporting option (GPRO) web interface required for participation. On top of that, two-thirds of its ACO is independent and together uses 31 different electronic health records (EHR) systems. This meant efficiently sharing and reliably analyzing data on attributed beneficiaries would have been very time-consuming. In speaking with the employed physician group that had used the GPRO web interface, the ACO learned that it consumed months of work and that they even hired an outside consultant to help with chart abstraction and care gap analysis.

KCN automated data collection and analysis for its participating independent practices and employed providers through its population health management platform. Instead of manually extracting data about each patient in each EHR, KCN’s platform automatically collects that data and delivers continuous quality performance progress updates. As a result, participating practices and their providers also have streamlined their workflows to ensure care gaps are addressed at the point of care throughout the year.

The Most Successful ACOs Share This One Quality

More specifically, the enterprise data warehouse (EDW) used by Kootenai Care Network, an Idaho-based ACO, combines clinical, claims, and demographic data from all sources available within the medical community participating in the ACO, says Karen Cabell, medical director, Kootenai Care Network/Kootenai Accountable Care. “We have an ACO-wide view of quality measure performance, but participating practices also have a dashboard view tracking all MSSP quality measures down to the provider or patient level. With this reliable, real-time intelligence, practices can monitor and improve performance during the year instead of waiting for updates from CMS. Through our platform, we also have access to claims data for internal reporting, which is a capability unavailable through some of our network’s EHR systems.”

Practices have further eased reporting by adjusting work flows, so data is collected and care documented accurately and fully on the front end. For example, providers generate a patient face sheet before every visit that lists identified care gaps to address for MSSP participation. Providers also generate a hierarchical condition category (HCC) code face sheet, which enables them to review the most recently diagnosed HCC codes for the attributed beneficiary. Those diagnoses can be confirmed and documented while the patient is in the practice, saving providers time and ensuring that the code is the most specific and appropriate for recertification with Medicare.

For the 2018 reporting year, after KCN loaded its registry file of more than 3,000 patients into our GPRO module, the platform automatically completed 57% of the gaps, eliminating the need for manual abstraction while reducing our total workdays to 20 from 46.5.

Since all of KCN’s data is integrated through the EDW, its population health management platform also is helping to reduce costs through a community-wide view of beneficiaries’ use. For example, if a practice does not have a patient’s recent mammogram results within its EHR, it automatically sees in population health platform that the exam was delivered by another provider in the community and can access those results.

“We have only scratched the surface of what is available through our population health management platform. In the coming years, we want to better utilize its referral management tools to ensure we are sending patients to the highest-quality providers in our network,” Cabell says. “We also want to improve care transitions by maximizing the amount of relevant information shared with providers at the next phase to support seamless continuity of care. Through the platform, all of this is possible.”

Shelley Janke, is director of quality and care management, Kootenai Care Network.

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Kootenai Care Network uses a population health management platform to reduce the burden on payers and providers.

Shelley Janke

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