This article appears in the May 2012 issue of HealthLeaders magazine.
Mountain States Health Alliance, a 13-hospital system based in Johnson City, Tenn., began thinking about becoming an ACO back in 2010 when it was working on its 10-year strategic plan. There was a general agreement among its leadership that what had historically made the system a success wasn't going to carry it forward in the future.
They began to see the ACO as a more sustainable model for the group. Mountain States submitted an application to CMS to participate in the Pioneer ACO program, but the application was rejected because MSHA couldn't commit to kicking off the ACO in January 2012.
MSHA didn't let the rejection end its ACO dreams. Instead, it repurposed the organization it planned to use for the Pioneer program into a commercial ACO, Anew Care Collaborative, with CrestPoint Health as the payer.
The regional ACO will provide services in the Johnson City and Kingsport areas of northeast Tennessee as well as the Abington area of southwest Virginia. Beginning in July, the ACO will house a commercial component consisting of Mountain State's 9,500 employees and a Medicaid component comprising Medicaid beneficiaries in southwest Virginia.
Mountain States is also evaluating its opportunities in the Medicare Shared Savings Program and plans at the minimum to file a letter of intent. If selected for the program, those beneficiaries would be housed in a separate Medicare component of the ACO.
Early last year, the 15,000 lives associated with the employee group were transitioned into CrestPoint Health to begin the process of managing employee health and wellness in a coordinated manner. Care models developed around congestive heart failure, pediatric asthma, and diabetes will be part of the ACO.
Among the first steps was to put in place front-end incentives of $750 (individual) and $1,500 (family) as seed money for each health savings account. That effort increased participation to 48% from 18%.
Additional incentives will be introduced around the theme of "get healthy, be healthy, stay healthy," including:
- Monetary rewards for using company wellness and fitness centers.
- A freeze on annual insurance premium increases for completing a health risk assessment.
- A copayment waiver for using MSHA's urgent care centers instead of the hospital emergency room.
There are no shared savings built into the first year of the commercial component of the ACO, but that may come later. It has negotiated increased payments, per member per month, to the primary care physicians to try to keep the population healthy and better manage patient health to avoid preventable hospitalizations or the use of other expensive healthcare services.
This article appears in the May 2012 issue of HealthLeaders magazine.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
