Provider Stories On the Ground: NC ACOs

You may have heard a few stories about ACOs the past few years. A few – in most markets there’s not a lot of track record so its important to learn from any ACO case studies we can.

ACOs overview

If you are not very familiar with the ACO-world (accountable care organization), an ACO is a type of contractual arrangement in which a provider group (or a health plan, or a combination of both) agrees to serve a certain population of patients in exchange for a certain level of quality or cost reduction (as defined by outcomes in the contract). The ACO also agrees to a defined pricing structure (usually a “bundled” rate for treating certain conditions). Most importantly, the ACO takes on risk. The ACO can lose money if quality or cost outcomes are not met; it can also make more money if it hits certain targets.

Results from a North Carolina ACO- 6 Years in

One of the latest ACO stories out there comes from New Bern North Carolina. The Coastal Care Quality Care ACO (CCQC) has about 40 physicians who see 11,500 Medicare patients. This ACO is part of the Medicare Shared Savings Program (MSSP). CCQC was started in 2012.

In the case of CCQC, the ACO can lose as much as 8% of their Medicare revenues. They can also gain up to 10% in bonus Medicare payments. That’s an additional $12M in rewards for the ACO for performing well.  With the MSSP, achieving savings (compared to costs in the absence of the ACO contract) is a key target. In the most recent 2 years, CCQC achieved about 5% savings on medical costs. They then get to share those savings with CMS.

Stories on CCQC lay out a couple of important tips for ACOs:

  1. It will take a few years for things to start working right in the new model. You can’t transition from fee for service to value-based care overnight.
  2. Focus on wellness checks, screenings and vaccinations – you won’t see the benefit in year 1, but you will start to reap the rewards in years 2 and beyond.
  3. EHR integrations, especially with prescribing systems, is key to improving patient targeting for improving care management.
  4. Don’t be surprised if physician engagement is low in the early stages. You have to work to get your docs to see the vision and the impact the ACO model has on patient outcomes and financial success.

Ways we can help with your ACO

Just planning or starting your ACO? We have provider data management solutions that can help with the initial lift. Whether you are a smaller ACO (like CCQC) or a large ACO (like some we have worked with in other markets), we can help you quickly onboard, credential and load all the important provider data you need to get started. Studies of provider experiences show deploying a Paragon solution significantly reduces provider administrative burden. And when you are implementing an ACO for the first time, you need to be able to take as much off your provider’s plate as possible.

Have an established ACO and fine-tuning operations? Many of our ACO clients are transitioning from the early stages and moving into the next phase of value-based care. They have worked out many of the operational challenges that limited savings achievement in early years. Now they are looking for other areas to optimize administrative functions to maximize performance and profit. Paragon solutions can reduce your network management costs, and onboard new providers as you scale your ACO.

To learn more about what Paragon can do to help, contact us online or by phone.

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