Essential value-based care competencies include robust data analytics, a compliance approach to coding, and an understanding of what makes an ACO successful at the clinic and individual provider level, says this CMO.
Medical groups and health systems have been implementing value-based care models such as accountable care organizations (ACOs) for more than a decade. But the fee-for-service model has remained stubbornly in place for many healthcare providers.
Wilmington Health has partnered with the AMGA to establish the AMGA Value Care Network, a strategic initiative designed to help medical groups and health systems succeed in value-based care.
In 2013, Wilmington Health launched one of the first ACOs in North Carolina, adopting the Medicare Shared Savings Program ACO model. Currently, Wilmington Health is operating an ACO REACH accountable care organization—a Medicare ACO model that involves full risk.
"The AMGA Value Care Network gives us an opportunity to help other medical groups," says David Schultz, MD, CMO of Wilmington Health. "We have developed competencies with our accountable care organizations, and we think we can share these competencies with other medical groups."
Wilmington Health expects to benefit from participating in the AMGA Value Care Network.
"For Wilmington Health, the AMGA has a large network of high-performing healthcare providers, and I expect that we are going to learn just as much from the partnership as our partners are going to learn from us," Schultz says.
David Schultz, MD, is CMO of Wilmington Health. Photo courtesy of Wilmington Health.
Keys to ACO success
To be successful in an ACO, a medical group must have several competencies, according to Schultz.
"These include data analytics, a compliance approach to coding, and understanding what makes an ACO successful down to the level of the clinic and individual provider," Schultz says. "We have this knowledge and can share it with others through the AMGA."
Data analytics are essential, Schultz explains. One big factor that contributes to the success of an ACO is trying to figure out who are the high-risk patients and who has rising risk.
"You can use data analytics to find out which patients are likely to have trouble and need more touches," Schultz says. "You can use data analytics to find out which patients need care designed around them such as chronic disease management."
Transparency is also crucial, according to Schultz.
"We have openly shared data on quality metrics among our providers," Schultz says. "We learned that we could quickly improve the quality of care just by being highly transparent."
Transparency also boosts the performance of clinicians. Schultz explains that when there is data transparency, there is rapid learning within an organization, and clinicians improve their performance.
"They ask questions such as why a colleague's screening rates are much better than theirs," Schultz says. "Those providers end up sharing information about what works. This is how transparency is helpful at the clinic level."
Access to care and data sharing have also contributed to Wilmington Health's success in value-based care, according to Schultz.
"You need good access to care for patients, which keeps your patients out of high-cost settings such as emergency rooms," Schultz says. "You need to give individual providers actionable information—providers need to step back from just seeing the patient in front of them and seeing their whole population of patients, with awareness of patients who should be in front of them."
Establishing a system of care around patients has also contributed to value-based care success at Wilmington Health, Schultz explains.
"When patients need complicated care or expensive care, you need to have your own specialists and lower-cost imaging centers that can drive down costs and improve quality as well," Schultz says.
By following best practices for value-based care, Wilmington Health has been a top performer in ACO REACH.
"Our savings in 2023 were $23 million," Schultz says. "We have other medical groups who are partners in our ACO, and they have also done well. Overall, our ACO REACH is among the best in the country—we have ranked in the Top 10 in percentage of savings. We also have been a high performer in quality metrics."
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
Wilmington Health has formed a partnership with AMGA to share its value-based care competencies with other medical groups.
In 2023, Wilmington Health generated $23 million in savings for Medicare, and the medical group is a top quality-metrics performer in its Medicare accountable care organization.
In value-based care, transparency is crucial because it encourages a high level of performance by clinicians.