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As MissionPoint ACO Turns One, Membership Up, Costs Down

 |  By jfellows@healthleadersmedia.com  
   March 06, 2013

Despite recent criticism that ACOs will not succeed because the behavior changes required of patients and doctors are "unrealistic," Tennessee-based MissionPoint Health Partners is moving the needle forward. 

MissionPoint Health Partners, an accountable care organization launched by Ascension Health's Saint Thomas Health System in Nashville just a year ago, is adding some health insurance heft to its operations. On Tuesday MissionPoint announced that Blue Cross Blue Shield of Tennessee will be joining the ACO in a four-year partnership aimed at self-insured employers.

That's just one indication that this ACO model is not only viable, but could be a lesson in how-to for other hospitals and systems considering plans to set up these new models of care.

Success Factors
In its first year, Jason Dinger, CEO of MissionPoint, says it surpassed membership goals. "We were hoping to manage 15,000 members; we're up to over 50,000 members in our ACO. We've seen considerable growth," says Dinger.

It also added new services, and expanded its telehealth component from one to 44 sites to capture the population residing in the rural area around metro Nashville.

And, Dinger says, the ACO has cut medical costs each year for its 15,000 original members by 12%.

Strategic Market is Key
One key to MissionPoint's progress with engagement may be its strategic target marketing to self-funded employers. According to Dinger, they share only one commonality—commitment to slowing costs for employees.

"They could be technology companies; they could be manufacturing companies. They could be 1,000 employees; they could be 10,000 employees. What's true for all of them is they are fully committed to ensuring that their health benefits are sustainable for their employees long-term, [and] that it doesn't overly burden their employees with growing healthcare costs."

Money is a powerful motivator, and that could be at play with self-funded groups that are closer to seeing to how medical decisions affect their paychecks than those relying on the employer to pick a carrier. Certainly, employees are looking closer at their options during annual enrollment, but Dinger says the self-funded groups it is working with know their populations well and are more engaged.

"We look at over 50 different indicators on a regular basis. We have seen a significant reduction in readmissions. We have seen increased physician visits among the population, and better adherence to medication," says Dinger.

It's important to remember the improved health and cost for MissionPoint's members don't exist in the healthcare industry vacuum of cost curves and new payment models. Health insurance can be a competitive advantage in the workplace for retaining and attracting employees, which could emerge as a sleeper indicator of the success of new payment models, even with a large wave of new members entering the system.

Getting BCBS-TN on board extends MissionPoint's access to the plan's more than 500,000 self-funded members.

Larry Nall, senior vice president of provider network management for BCBS-TN, says the insurer was intrigued with MissionPoint's 2012 ACO announcement and has tracked its progress since.

"One of the things we've been doing is looking for strategic partners around the state," says Nall. "What we will do is make it available for self-funded employer groups as of Jan 1, 2014. As we continue the partnership, [we'll explore] how to make it available for other funding types. There are a lot of details to work out, but we picked the right partner."

Data Sharing
Currently MissionPoint looks at 3-5 years of historical data as a starting point for care. Then it customizes a health plan with interventions designed to improve the health of its members, based on their medical conditions.

When the ACO option is rolled out to employers next year, MissionPoint and BCBS-TN, like other ACOs, will share claims and clinical data to determine the best path of care.

Dinger says employers get health information quarterly, or as needed, depending on the size of the employer group. He points to allied health partners his organization has added to the MissionPoint ACO as evidence the infrastructure exists to take care of the extra patients from BCBS-TN.   

"We now have over 1,500 providers in our network throughout the middle Tennessee area," says Dinger. "We've also brought on a number of allied health and post acute care partners in the areas of durable medical equipment and skilled nursing facilities."

'Bear Hugs' for Sickest Members
Dinger offers some lessons learned after a year of running the only ACO in the midstate. He says there are basically three levels of intervention:

  • Chronic, complex, medical cases
  • Employees who are regular users, but may need help identifying appropriate prevention strategies
  • Wellness

The sickest members get what Dinger calls a "big bear hug"—home visits, call center support, and regular engagement based on their daily healthcare needs. This is the group that's seen the most dramatic improvement, according to Dinger.

"The results that we've seen in year one are largely from that first intervention, providing services to people who are managing really complicated illnesses and working with them to reduce their own costs and improve their outcomes," says Dinger.

Is the 12% cost reduction Dinger says MissionPoint accomplished in its first year bending the cost curve enough to silence, or at least hush (they are Tennesseans, after all) the detractors of ACOs? It's unlikely, but first steps are always clumsy.

Happy first birthday, MissionPoint.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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