In July 2020, the Centers for Medicare & Medicaid Services (“CMS”) released part three of its ongoing Accountable Care Organization (“ACO”) Learning System and Toolkit Series: Provider Engagement Toolkit (the “Toolkit”), focusing on strategies to effectively engage healthcare providers in the ACO and in quality improvement activities.  In particular, the Toolkit showcases the various effective strategies Medicare ACOs are currently using to help primary care and specialty providers in the ambulatory setting to improve health care quality and overall patient outcomes.

Since 2012, CMS has supported ACOs in their goals to improve the delivery of care for their patient population, including through its ACO Learning System Toolkits that provide ACOs with a community in which they can collaborate and cultivate innovative strategies to improve the delivery of patient care.  Accordingly, similar to previous CMS ACO toolkits, which include the Care Coordination and Beneficiary Engagement series, CMS aims to educate the public on actionable ideas ACOs have and intend to implement to enhance value-based care as well as to help current and prospective ACOs with their operations.

In taking a closer look at the issue of provider engagement, CMS underscores the importance of effective engagement and discussions with current and prospective providers under the ACO model and how this is critical to motivating the value-based care transformations necessary to improve patient health outcomes, and impact beneficiaries’ acceptance and comfortability with the ACO model.  According to the Toolkit, these discussions which are tailored to clearly articulating ACO operations, goals, strategies, and as importantly, how participating providers can support these strategies, can significantly reduce the potential for confusion and uncertainty providers at times express when asked to relay their understanding of how the ACO would enhance patient care.

As provided below, this new resource, explores the multifaceted approaches ACOs use to successfully communicate with providers while addressing opportunities for improving patient care.

KEY STRATEGIES ACOS MAY IMPLEMENT WHEN CONVEYING THEIR ORGANIZATIONAL GOALS WITH PROVIDERS:

Leverage leadership to promote culture change and utilize visual tools.  Under this Toolkit, CMS notes several best practices ACO administrators use to clearly convey ACO goals and promote provider buy-in, which include understanding how to leverage leadership to promote culture change within the overall healthcare provider setting and using visual tools to clarify the ACO’s strategy.  With respect to culture change,  CMS emphasizes the ACO’s ability to hone in on reshaping provider culture related to concepts surrounding population health and value-based care, including coordinating care, engaging beneficiaries, and making community-based support systems readily available to address the social determinants of health.  Thus, when engaging practice leadership, ACO administrators encourage meeting one-on-one with leaders of primary care and specialty practices to establish meaningful relationships and communication pathways.  During these meetings, ACOs are encouraged to discuss the values of the ACO, and inform providers of the improvements in both care coordination and access to benefit enhancements, under the ACO model, that increases the beneficiary care experience and outcomes, which will in turn be communicated to the practice staff.

In addition, ACOs have found that their collaboration with internal stakeholders—who have administrative, clinical, and information technology skills—when developing visual tools to clarify ACO strategies has proven effective when presenting these strategies to providers.  For example, the driver diagram, which shows the relationship between the overall goals of the ACO, continues to prove itself useful for assessing performance, articulating ACOs’ goals, and promoting change at a local level.  Moreover, when communicating with providers, ACOs are highly encouraged to maintain consistency by using the same concepts and vocabulary to describe their organization to providers and their staff.  Overall, these mechanisms promote ACO transparency and allow providers to have a better understanding of how ACOs operate in general, and how ACOs intend to achieve cost and quality goals as well as results in incentive payments that may motivate provider participation in this alternative model of care.

Create clear and multiple lines of communication about the shift to value-based care.  In bridging the communication gap between ACOs and providers on the issue of shifting from a Fee-For-Service (“FFS”) environment to value-based care, ACOs are strongly encouraged to use multiple forms of communication when engaging providers in value-based care operations and when describing their approaches to improving the delivery of care which include the use of: written electronic communications (i.e., web-based portal and emailed newsletters), podcasts and online trainings, and interactive meeting and informal gatherings with participating providers to encourage engagement.  These forms of communication are helpful in ACOs’ distribution of news and important information about organizational strategies, model or program policy, and incentives available to participating providers.

Elicit provider input and feedback.   Addressing best practices when eliciting input and feedback from providers on ACO operations is crucial to provider retention and expansion of ACOs.  In this regard, the Toolkit provides several approaches to elicit provider feedback such as identifying liaisons to lead peer-to-peer communication among providers and their staff, and inviting provider representatives to join ACO governing committees.

UTILIZE DATA TO IDENTIFY AND ADDRESS OPPORTUNITIES FOR IMPROVING PATIENT CARE:

Develop and deliver provider-level feedback and action-oriented reports.  An effective strategy ACOs take into account when identifying and addressing opportunities for improving care and provider engagement includes the development and delivery of provider feedback reports.   Such reports customarily highlight a practice’s and individual provider’s performance on key measures including: total cost of care, hospital admission rate, use of the emergency department, and the completion rate of preventive services, such as annual wellness visits, flu vaccinations, and mammograms.  The Toolkit further addresses how many ACOs then supplement these feedback reports with action-oriented data reports and educational materials that pinpoint the gaps in beneficiaries’ care and provide possible approaches to assist providers and their staff to improve their delivery of care.

CUSTOMIZE SUPPORT FOR PRIMARY CARE AND SPECIALIST PROVIDERS:

The Toolkit further outlines strategies in which ACOs consider when customizing support for primary care and specialist providers in the delivery of high quality, population-based health care.  When discussing approaches to population-based health care, primary care providers voiced concerns of time and staff constraints limiting their ability to effectively coordinate care and to educate beneficiaries with complex conditions about managing their own health.  On the other end of spectrum, specialists noted that, due to their focus on specific conditions and diagnoses, and treatment of patients who are often sicker than the average Medicare beneficiary, it is more difficult for them to achieve population-based health care.  In response to these issues, CMS highlighted the following proven strategies ACOs used when developing quality customized support for both primary care and specialty providers:

• Engage with individual providers to understand their preference for support, recognizing that a tailored strategy is the best way to meet the needs and interests of a diverse array of primary care and specialist practices.

• Provide individualized, hands-on coaching to help practices identify and test initiatives that are designed to make the delivery of care more efficient and effective.

• Employ population health teams to help practices address the population health needs of their beneficiaries and to reduce the burden on individual providers and their staff.

IMPLEMENT FINANCIAL INCENTIVES:

Lastly, the Toolkit highlights the use of financial incentives to motivate providers to help ACOs improve the quality of care for their beneficiaries and meet their thresholds for achieving shared savings through the following means:

• ACO board members and other stakeholders should work collaboratively to determine the proportion of shared savings to allocate to shared saving payments, to ACO infrastructure, and to redesigning care processes.

• Evaluate which metrics to use for awarding shared savings payments based on the availability of data, the strength of the evidence base that underlies the metric, the ability of clinicians to take action to improve their performance, the conciseness of the overall measure set, and the alignment with measures used in other value-based contracts.

• Reevaluate benchmarks for shared savings metrics to ensure that they are ambitious enough to encourage ongoing quality improvement.

In sum, physician engagement is imperative to an organization’s transition to value-based care.  Through this Toolkit we are better able to discern how ACOs approach the engagement of health care providers from multiple organizational levels to improve the delivery of value-based health care.  With ACOs being provider-driven models, it is essential that ACOs continue to bolster provider engagement strategies to better communicate and educate providers about their goals and operations.