Northern Light Health Accountable Care Organization

Description

In 2012, Northern Light Health, which serves the state of Maine, began an Accountable Care Organization (ACO) network through its population health branch, Beacon Rural Health. Beacon Rural Health partners participate in the Medicare Shared Savings Program (MSSP).

Although family providers initially had a sense of losing control due to ACO quality measures and guidelines, they realized the thorough data required by CMS helps them provide more seamless and personalized patient care in the long run. Providers participating in the Northern Light Health network now have concrete, quality information to support continual process improvement that encourages and promotes consistent care. Patients are experiencing improved quality of life and care that is tailored to their needs and is more affordable. By making healthcare more proactive and offering specialized care management, the network is achieving cost savings for Medicare, employers, and patients.

As an ACO, Northern Light Health is able to support primary care medical home teams. Being part of larger organizations gives smaller practices the opportunity to invest in people and programs such as licensed social workers and community health workers who would have been out of budget range otherwise. Practices also have potential access to new grant funding. The real-time data, human capital, and other general resources are tools many rural sites would not have access to on their own.

Services offered

• Clinical coordinators who help patients understand healthcare and guide patients to the most appropriate clinical and social services.
• Specialized nurse care manager for patients with chronic disease, recent emergency department visit, or discharge from a hospital or skilled nursing facility.
• Community care teams, including nurses, licensed social workers, and community health workers who help patients access social services in their homes and local communities, support and mitigate barriers related to behavioral health and substance use disorders, and increase access to clinical care through home visits and telehealth for the most vulnerable groups of patients. Community health workers also complete social determinants of health intervention for all patients who endorse social needs and agree to assistance to resolve these barriers.
• Data surveillance and analytics. This infrastructure is imperative in tracking quality measures and metrics not only required by Medicare but also health insurance providers.
• Patient feedback systems, patient representatives attending the Northern Light Health ACO monthly Population Health Conference, and advisory group gatherings for parents and providers.

Results

Since 2012, Northern Light Health has grown from a network of 9,000 Medicare beneficiaries to 28,000, as well as commercial plans including nearly 16,000 employees and dependents on the Northern Light Employee Health Plan. The program cares for roughly 95,000 individuals across Maine, most of whom reside in rural and medically underserved areas. The high-value network now has 240 primary care providers and 690 specialty providers.

In 2013, the nurse care manager program was accredited by the National Committee for Quality Assurance (NCQA), has maintained certification, and most recently recertified in 2023.

The cost-saving measures initially targeted by Northern Light Health ACO were potentially avoidable emergency department visits and hospital admissions and readmissions.

Shared savings included:

• First Agreement Period
  • Performance years 2016-2018: $0
• Second Agreement Period
  • Performance year 2019: $2,060,209; returned ACO Investment Model funding of $1,745,716
  • Performance year 2020: $4,163,076
  • Performance year 2021: $0
  • Performance year 2022: $1,690,220

Northern Light Health has observed:

• Reduction in unnecessary emergency department visits.
• Reduction in avoidable admissions for asthma, heart failure, and chronic obstructive pulmonary disease (COPD).
• An increase in patient satisfaction and engagement in their care.
• Coordinated care and outreach that has cut out unnecessary/duplicative and preventable procedures.

Challenges

• Having nurse care managers requires the forethought in budgeting to fund these new ACO teammates.
• Data surveillance and analytics require a hefty investment.
• "Team sport" mentality can take some adjustment. It is important for providers to realize that their responsibility extends beyond their office and that they have a team to support them.
• There are multiple quality measures that providers must keep in mind, and that can be a bit overwhelming. This includes answering to the hospital administration and measurements from the ACO.
• Social barriers are a significant contributor to overall health outcomes. There is a high percentage of social need throughout the population in Maine, including Northern Light Health patients. The needs/demand outweigh the availability of community-based services to meet these needs and wait lists are high.
• Staffing challenges post COVID and access to skilled nursing facilities remain a challenge.

Replication

Provider involvement and leadership are necessary to make an ACO work among multiple practices. In addition, nurse care managers, social workers, community health workers, and data analytic experts are potentially the most important factor in managing the array of healthcare services residing within an ACO. Embedded care managers are more effective than outsourced programs, as they can visit both patients and providers in person.

Additionally, embedded care management documentation is completed and contained within the primary care electronic medical record, including the integrated care plan, making it readily available and accessible to the full primary care team.

Contact Information

Heather Mullen, VP Value Based Care Integration
Northern Light Health
hmullen@northernlight.org