Montefiore ACO is part of the Montefiore Health System, which includes 11 hospitals and a primary and specialty care network of more than 180 locations throughout New York. In 2012, Montefiore was selected as the only Pioneer accountable care organization in New York City. In 2017, it became a next generation model ACO.
These models represent government efforts to transform healthcare payments to be based on quality and outcomes of care, rather than the number of patients being seen.
As of 2018, Montefiore ACO includes 5,000 providers, approximately 70 percent of whom are directly employed by Montefiore. The remaining providers are independent physician practices. Together, through the next generation ACO model, we cared for more than 50,000 Medicare beneficiaries, with the shared goal of delivering the highest quality care in the most cost effective way.
"Data is used to disseminate provider feedback reports, displaying measurable performance across preventive care, chronic condition management and resource utilization"
With this goal, Montefiore, through its care management organization’s quality improvement team, developed and implemented a provider engagement strategy. The strategy focuses on implementing Health Information Technology (HIT), Population Health Management tools and applications to support providers as they embark on value-based payment models like the Next Generation ACO.
Engagement activities include, providing state-of-the art technological support to enable data reporting, tracking quality metrics and care coordination. We are also hyper-focused on connecting providers to care management services focused on patients’ medical and behavioral health care needs as well as their housing, dietary, legal, educational and economic challenges to address social determinants of health.
The quality and provider engagement is segmented into three major domains to improve patient experience and linkage to primary care, specialty and community based services.
1. Awareness and education
2. Process and change management
3. Behavior sustainability
The model starts with a comprehensive assessment of practices and providers to determine the appropriate use and engagement approach. This includes determining “meaningful use” of Electronic Health Record (EHR), availability of EHR-based tools such as registries, dashboards, reporting tools, decision support tools, use of assessments critical to quality measure reporting, and most importantly, commitment to engagement in ACO-led clinical improvement activities.
Technology in Montefiore’s Quality and Provider Engagement model
Awareness and Education Based on the assessment results, the Montefiore team engages individual practices and facilities. This includes one-on-one sessions between the quality specialist and physicians, and administrators, to discuss provider clinical performance and patient data.
Data is used to disseminate provider feedback reports, displaying measurable performance across preventive care, chronic condition management and resource utilization. Coaching practices to connect to regional Health Information Exchange (HIE) modules has been key. By facilitating access to Regional Health Information Organization (RHIO) and the use of Admission/Discharge/Transition of care (ADT) applications, we are able to have a clearer method of receiving alerts when patients come to the hospital.
Providers are then able to improve care coordination, patient engagement and quality goals through these reports and feedback. Incentive opportunities are linked to higher performances.
Process and Change Management Using structured change concepts, Montefiore ACO team stands by the notion of facilitating process improvements to achieve desired outcomes. For example, Montefiore ACO funded digital retinal cameras, to allow independent physician practices to perform diabetic retina screening exams on site. Physicians and staff use the cameras to photograph a patient’s eyes while the patient is there for an existing appointment. The physicians then send the image electronically to an eye specialist. By helping practices integrate retinal specialty services into their workflow, the quality improvement team helped practices to improve their performance on diabetes eye exam measures.
This practice change led to Montefiore ACO’s performance across its value-based contracts in diabetes retina screening exams to increase from 21 percent in 2013 to 72 percent in 2017.
Montefiore ACO has also seen an increase in electronic health record utilization by 42 percent in the last 4 years (2014-2018), by providing practices guidance and access to low-cost technology and resources to enhance adoption.
As practices establish fundamental infrastructure to support the quadruple aim, Montefiore enables technology to scale out standard practices and resources. For example, the implementation of patient engagement tools, such as Interactive Voice Response (IVR) technology has enabled Montefiore ACO to set automated processes to outreach patients with gaps in care and with a hospital or ED event. We are encouraged by these results.
By working closely with providers, both in and outside of Montefiore, we’ve been able to increase quality of care, and streamline processes across the healthcare system. With health information technology as our anchor, our goals are to continue to deliver more resources to community providers and leverage shared resources to further improve care and importantly, create stability in the cost of care.