Better Community Care Through Collaboration
At the ACO, we are a provider-led entity that is working together to create the future we all want, with high-quality care, improved efficiency and outcomes, lower costs of care, and increased patient and provider satisfaction. Our vision for the future is a system that allows providers to spend time seeing and helping patients. We partner with health insurance companies, hospitals, independent medical practices, and the community to help ensure that patients get the care they need when they need it at the lowest possible cost overall. We provide our network partners, such as doctors and other providers, access to data, resources, and tools to improve patient health and ultimately lower the cost.
Together our goal is to make our community healthier and stay healthier by focusing on managing chronic illnesses, improving access to primary care, and behavioral health services in New York.
Table of Contents
Message from our CEO
Message From our Board Chair
ACO Year Review
Network Performance
Financial
ACO Strategy
Prevention
Network Participants
AIM of Adirondacks ACO
We strive to alleviate the administrative burdens by providing our network partners access to data, resources, and tools to improve patient health.
Adirondacks ACO continues to focus on impacting these areas to achieve high-value health care delivery in our region in 2022
To Provide Health Care Support to our Network Providers
Boost the Overall Patient Experience
Improve the Health of our Community
A Message From Our CEO, Eric Burton
This is where the message from Eric will go
A Message From Our Board Chair, David Beguin, M.D
This is where the message from Dr. Beguin will go
Adirondacks ACO Results
Even with a global pandemic, Adirondacks ACOs network continued to achieve goals and work hard to continue the quality of care for the network participants
Shared Savings
The goal of the Adirondacks ACO Model is to move the health care delivery system from what we know as volume-based to value-based payments. Our network providers can achieve shared savings to meet financial and Quality goals that benefit the community with this approach. This way, we can ensure that patients, especially our most vulnerable community members with complicated health issues, and help our network providers reinvest in the community.
Adirondacks ACO Receives $3M in Savings from the Medicare Shared Savings Program
Despite the difficulties of CVOID-19, Adirondacks ACO providers focused on serving their patients and continued to provide high-quality care throughout the pandemic. As a result, for 2020, we increased our overall Medicare Quality Score, which translates to receiving 39% of the possible 40% of our total savings.
In the Care Coordination/Patient Safety domain, we earned 7.70 out of 8 points. There were strong improvements in the Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions and Ambulatory Sensitive Condition Acute Composite measures. One area that did see a significant decline is Falls: Screening for Future Falls Risk measure went from 83.81 in 2019 to 77.15 in 2020.
In the Preventive Health domain, we earned all of the possible 12 points. The ACO made improvements in four out of the six measures. Influenza Immunization, Colorectal Cancer Screening, and Breast Cancer Screening saw significant improvement earning Quality Improvement Reward points. One measure saw a considerable decline, Screening for Depression and Follow Up Plan dropped to 74.64 in 2020 from 80.89 in 2019.
In the At-Risk Population domain, we earned 5.55 out of 6 points. In 2020 ACO providers made improvements in Controlling High Blood Pressure and Hemoglobin A1Cs but saw a significant decline in Depression Remission at Twelve Months.
According to the National Association of ACOs (NAACOS), overall, the Medicare Shared Savings Program ACO model served 10.6 million seniors in 2020 and collectively achieved $4.1 billion in gross Medicare savings and $1.9 billion after accounting for shared savings payments. They earned an average quality score of 97.8%.
2020 Commercial Quality Snapshot
Need a blurb about quality
2021 Quality Highlights
At Adirondacks ACO, we have continued on our positive trajectory for 2021. Although our Network has faced obstacles, we have collectively worked with our Network to ensure we can continue to see positive outcomes.
For 2021, Adirondacks ACO has decided to continue the tiered approach for Commercial Quality. This approach will utilize the NYS QARR benchmarks. Seeing this is a process we are all familiar with, it was decided to continue due to the success we have been seeing.
Adirondacks ACO will be rolling out a Six-month pilot with Empire BCBS to support the Healthy Steps program. This pilot program supports the extensive screenings of child/family to provide care coordination and support for the family. Healthy Steps will be piloted at Plattsburgh Primary Care and Mountain View Pediatrics.
Adirondacks ACO will also be working with network providers to assess their ability and readiness to move to electronic clinical quality measurement (eCQM’s), as CMS Medicare Shared Savings Program will require the quality submission to be via eCQM’s in the measurement year 2024.
Adirondacks ACO Progress and Accomplishments
When working as an ACO, our care goals become apparent when we work together with our network providers and community members.
National Alliance for Mental Illness – Champlain Valley (NAMI-CV)Partnership
To meet our shared goal of moving toward whole-person care, it is vital to expand our partnerships to include a range of providers. In 2020, Adirondacks ACO partnered with the National Alliance for Mental Illness – Champlain Valley (NAMI-CV) to provide supportive, certified peer services to our Fidelis attributed members in Clinton County.
The HOPE Team (Healing by Overcoming obstacles through Peer Empowerment) has provided a range of services to augment the care management that many of our network partners offer in 2021.
Adirondacks ACO shared a list of 179 high-risk Fidelis members with NAMI, and they have been reaching out and working with them to ensure that they have the support they need, particularly during this challenging time. Since sharing the list, we collectively see a positive impact on the partnership.
Northwinds Integrated Health Network: Connecting Data & Quality Improvement
To meet our shared goal of moving toward whole-person care, it is vital to expand our partnerships to include a range of providers. In 2020, Adirondacks ACO partnered with the National Alliance for Mental Illness – Champlain Valley (NAMI-CV) to provide supportive, certified peer services to our Fidelis attributed members in Clinton County.
The HOPE Team (Healing by Overcoming obstacles through Peer Empowerment) has provided a range of services to augment the care management that many of our network partners offer in 2021.
Adirondacks ACO shared a list of 179 high-risk Fidelis members with NAMI, and they have been reaching out and working with them to ensure that they have the support they need, particularly during this challenging time. Since sharing the list, we collectively see a positive impact on the partnership.
ACO Strategy
Needed
Financial Highlights
Need
2022 Contracting Strategy
Adirondacks ACO has decided to replicate the 2021 Contracting Strategy for 2022–for working with our six commercial and Medicaid payer partners across our region.
The Strategy outlines our guiding principles for 2022 and looks down the road, laying out our long-term outcomes.