Shore Quality Partners earns millions in Medicare ACO bonuses with pop health platform
Shore Quality Partners, a clinically integrated network and accountable care organization based in Somers Point, New Jersey, had a problem: a massive volume of patients and claims data but no effective way to manage or aggregate that data.
Staff were able, through a manual process, to look at trends and utilization. But that was only a short-term solution. It wasn't sustainable.
Staff also had issues trying to calculate utilization, such as rates per 1,000, from the massive amounts of data received. They needed a solution that would take their data, scrub it and automatically push the relevant data and insights into a single system to share with leadership, providers and care teams.
So Shore Quality Partners turned to HealthEC, a vendor of a data aggregation and population health platform.
"The pop health system offers everything we were looking for," said Shea Wisler, manager of population health at Shore Quality Partners. "It is able to take data directly from payers, scrub the data and then upload the data into its platform. It was automatic and seamless. By doing this, we are able to get a bevy of standard reports that HealthEC had prebuilt."
The other critical component the platform solved was to present the data on the tax identification number level and also at the national provider identification level.
"We have achieved shared savings for our Medicare ACO in 2017, 2018 and 2019; 2019 was our biggest bonus, at $2,046,871."
Shea Wisler, Shore Quality Partners
"Our providers were asking how they were performing compared to other physicians and wanted more insight into their own practice habits," said Chelsea Hope, LPN, LPN care coordinator at Shore Quality Partners. "By having the data drilled down to the NPI level, we are able to show providers their own data for their own patients. This provides important insights into their clinical performance patterns and behavior."
Shore Quality Partners initially blinded all the data. Providers could see their own data, as well as everyone else's, but not the names of the providers. This gave them autonomy, while they could still view their own data.
"Eventually, the providers became confident enough in the data and with each other to unblind the data and compare everyone against each other," Hope revealed. "This was an important step, as now the providers can hold each other accountable and have access to data-driven insights to improve how they deliver care."
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MEETING THE CHALLENGE
Staff uses the pop health platform almost daily.
"We look at current trends, utilization and spend," Wisler noted. "We drill down into these at the TIN, NPI and member level. We have an executive director, manager of population health and two care coordinators who use the technology. It is not currently integrated with any systems. However, we are in the process of integrating HealthEC with our athenahealth EHR."
Once the organization integrates HealthEC with athenahealth, physicians will have access to real-time, up-to-date information, in addition to the data the organization currently receives, Hope explained.
"By having the data drilled down to the national provider identification level, we are able to show providers their own data for their own patients. This provides important insights into their clinical performance patterns and behavior."
Chelsea Hope, LPN, Shore Quality Partners
"This will help with more automatic quality gap closure," she said. "We can also tap into the EHR's scheduling module so we can identify – through claims and the EHR – patients who have not been seen so far this year, along with a bevy of other options."
Staff will build care "scorecards" for each member that providers can use during the patient visit. These will have relevant information such as quality metrics, ER usage and dates, inpatient usage and dates, other providers utilized, pharmacy data, risk scoring, and more.
"We have achieved shared savings for our Medicare ACO in 2017, 2018 and 2019; 2019 was our biggest bonus at $2,046,871," Wisler reported. "We also have achieved shared savings for a commercial payer in 2015, 2017, 2018 and 2019. 2019 was our biggest bonus as well, coming in at $2,473,654. In 2019, we also achieved 6/8 quality metrics at the 90th percentile for commercial and a total quality score in Medicare of 92%."
The pop health technology tracks quality metric score to show how the organization is doing. Within that tracking, it also shows which quality gaps, by member, are still outstanding. From there, care coordinators and the practice care coordinators conduct outreach to the member to schedule an appointment or help close the quality gap needed.
"The pop health platform makes it quite simple and efficient for our leadership, providers and other clinicians to know what we need to do," Wisler added. "The platform also is used to track our spend over time. By doing this, we can see where our spend is, compared to other years, as well as current trends for that year. We can identify where we might be spending more money than last year and dig into the root cause."
For example, Shore Quality Partners might be spending more in cardiology services this year versus last year. Is that because the members need more services or because the members are utilizing a new or different cardiology practice or facility that is more expensive?
ADVICE FOR OTHERS
"When implementing a new population health management platform, do not take any shortcuts during implementation and spend time vetting the data as well as setting up your technology correctly," Wisler advised. "Implementation can take some time to accomplish, but that can be a good thing for data integrity and provider confidence."
It's important to vet the data correctly during this process, so there is confidence that the data received from the technology is correct, he added. The worst thing one can do is have data that is wrong, which erodes the confidence of leadership and clinicians, he said.
"Once that confidence erodes, it's difficult to get that back," he concluded. "And make sure your network of in-network providers is correct. Ensure data mapping is correct and accurate. Everything plays into the accuracy of your data. This can take time, and may require having to tweak different settings. But these efforts pay off in the long run for every stakeholder, especially your providers."
Championing the caregiver experience
This special collection, which will be updated throughout the month, looks at what's being done to ease the burden on providers impacted by COVID-19.