ACN Advance - July 2021

Direct Contracting Model Replacing NGACO in 2022

New & Expanded Payer Partnerships Boost 2022 Outlook

New Opportunity With HCC Reconciliation Program

Specialist Performance Reports Available for Your Practice

Available Tip Sheets Support Care Gap Closures

News Roundup

Welcome, New Provider Organizations

Todd Ricotta accepted the role of Chief Executive Officer with Arizona Care Network in June. A dedicated leader at ACN since its inception in 2013, Todd most recently led ACN’s network development initiatives and drove successful payer partnerships and strategies as the organization’s Chief Operating Officer, and as the organization’s interim CEO (2019-2020).

Todd’s appointment as CEO follows Conley Cervantes’ decision to pause her career to focus on family priorities, a difficult professional decision but an easy personal decision for Conley. Both Todd and ACN’s Board of Managers expressed gratitude toward Conley for her leadership, efforts, service on ACN’s joint venture board, and overall commitment to ACN. Todd joined ACN in 2013 as its Executive Director and has worked in the healthcare industry since 1995, holding various hospital administration, health plan and business development roles in the not-for-profit, for-profit, public, and private sectors. He earned both a master’s in business administration (MBA) and a master’s in health services administration (MHSA) from Xavier University. Todd and the rest of ACN’s leadership, together with the ACN Board of Managers, will focus efforts on a successful transition to a new Medicare ACO model for 2022, deepening existing relationships and forming new partnerships with payers, and effectively supporting the network to bring value to the provider organizations participating with ACN. Please reach out to Todd directly at todd.ricotta@azcarenetwork.org with any feedback or input to share as we set a course for 2022 and beyond.

In lieu of the Center for Medicare and Medicaid Services’ (CMS) decision to discontinue the Next Generation ACO (NGACO) model, Arizona Care Network has applied with CMS to transition its Medicare ACO program to the Direct Contracting Model, beginning in 2022. The Direct Contracting Model builds upon the NGACO model that ACN has operated since 2017, and offers advantages over the Medicare Shared Savings Program (MSSSP), and even the NGACO Model. DCM features include:

• Available to PCPs and Preferred Providers filed by ACN with CMS by Sept. 10, 2021;
• Qualifies as an Advanced Alternative Payment Model (APM) under the Quality Payment Program (QPP), which preserves 5 percent lump sum future bonus for participating primary care providers;
• The ability to designate specialists, facilities, and ancillary providers as Preferred Providers in the program, similar to the NGACO Model;
• Simpler quality model with claims-based data utilization metrics.

ACN will be sharing additional information throughout July upon application approval, and as important features of the Model are clarified for applicants. In the meantime, if you are interested in participating in the Direct Contracting Model in 2022 or learning more about DCM, please contact your Clinical Performance Consultant directly or email practicetransformation@azcarenetwork.org with any questions.

ACN has formed several new payer partnerships and further expanded its relationship with Aetna to continue enhancing the value to provider organizations participating with Arizona Care Network. Newly formed relationships with Alignment Health, Employers Health Network (EHN), and Medica aim to both strengthen and increase ACN’s footprint of covered lives throughout Maricopa and Pima counties in 2022 and beyond.

Professional Fee Schedules for the Alignment, EHN, and Medica partnerships were approved by the Board of Managers during its June meeting, and will be distributed later this year.

If your practice or TIN has a different network arrangement for your Aetna MA lives, and are interested in learning about the opportunity to participate under ACN’s arrangement, please contact your Clinical Performance Consultant directly or email practicetransformation@azcarenetwork.org.

ACN is expanding the Hierarchical Condition Category (HCC) Reconciliation Program to directly support your practice in identifying HCC opportunities for your ACN Medicare patients. This ICD-10 based diagnosis categorization/classification system is used by CMS to establish financial benchmarks and improve quality by ensuring your practice accurately depicts expected cost(s) of caring for your patient population. ACN’s HCC team will review patient medical records daily and identify risk adjustment coding opportunities for your providers to consider during a patient’s appointment. ACN’s support in risk adjustment coding allows your staff to focus on other tasks within your practice. Practices that wish to participate will need to provide remote EMR access and establish a direct point-of-contact to provide your HCC opportunities. Upon receiving remote EMR access from your practice, our HCC team member will access and review your daily appointment schedule for risk adjustment coding opportunities for patients scheduled three (3) days in advance. Our HCC team member will communicate any identified HCC opportunities via email (or your preferred communication method) to the direct point-of-contact one (1) day before the appointment. Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org if you wish to participate. We will notify you when an HCC team member will be assigned to your practice to start the process.

Good news for specialist practices: To further support your patient care and improve the network's care coordination, ACN has launched a new suite of reports for specialty practices, designed to provide insight into your practice’s ACN patient population. The reports include actionable data on accessing in-network care for professional, outpatient, and inpatient services. These tools are also intended to assist your office staff when coordinating care within the network. These reports include:

• Detailed summary of unique ACN members seen in 2019 and 2020 (as applicable), broken down by practice location and individual provider
• Overview of ACN members readmission rate, post discharge follow-up and network utilization for inpatient and outpatient facilities, and office-based procedures for elective services performed on ACN members at the group and servicing provider level
• Summary of the ACN network average for inpatient facility alignment, outpatient facility alignment, 30-day all cause readmission rate, and 30-day post discharge follow-up visit rate per specialty

Future reports for select specialties will be available on a quarterly basis from your Clinical Performance Consultants. Please contact your CPC or email practicetransformation@azcarenetwork.org to receive these reports, schedule an opportunity to review them with your CPC, or with any questions.

To support your practice in closing any value-based quality care gap measures among your patient population, ACN has put together a series of 1-page “tip sheets”. Each tip sheet (.PDF) covers one of these common quality measures:

• Colorectal cancer screening
• Depression screening and follow-up
• Diabetes (A1C, Eye Exam, Nephropathy)
• Social Determinants of Health (SDoH)
• Tobacco screening

Each 1-page sheet contains best practices, documentation requirements, and codes to submit for your practice to close these quality gaps. Please look forward to future quality measure tip sheets that will cover additional quality measures that ACN is measured upon by our payors. Please contact your Clinical Performance Consultant directly or email practicetransformation@azcarenetwork.org if you’d like to receive any or all of these 1-page tip sheets.

• Follow us on Facebook, Twitter, and LinkedIn for additional news, health-related content for providers and patients, organizational updates, and more.
• Learn more about ACN’s Care Coordination program and services designed to partner and support your practice in achieving healthy, cost-effective patient outcomes in this video.
• Phoenix Children’s Hospital – Arrowhead Campus, a freestanding three-story pediatric hospital on the north end of Abrazo Arrowhead Campus, is expected to open in 2024. Phoenix Children’s Hospital – Arrowhead Campus will offer inpatient care, an emergency department, an outpatient surgery center, and a multi-specialty clinic.
• Quick reminder: If your practice includes any patients covered through Intel’s Connected Care, blood pressure cuffs for home use may be a covered benefit under your patient’s Connected Care plan. For your patient population not covered through Connected Care, discounts on home blood pressure machines may be available through local and major retailers and pharmacies.
• OB-GYN providers: The Maternal Health Innovation Program at the Arizona Department of Health Services will be hosting three virtual maternal mental health training opportunities from Aug. 11-13. CME credit opportunities are available, and registration ends on July 30. ADHS is providing full scholarships to Arizona participants. Contact Orrin Banta at morrinbanta@postpartum.net before you register for a coupon code. Topics include Perinatal Mood Disorders: Components of Care (Aug. 11-12); Advanced Perinatal Mental Health Psychotherapy Training (Aug. 13); and Advanced Perinatal Mental Health Psychopharmacology (Aug. 13). More information for the Aug. 11-12 program is available here; and available for the Aug. 13 program here.
• Passes are available for purchase to attend any of the seven Quality & Innovation Series discussions sponsored by the National Committee for Quality Assurance (NCQA). This year’s all-virtual topics include telehealth best practices, behavioral health, health equity, measurement and reporting, and more.

Welcome, New Provider Organizations!

• American Vision Partners (name change only; formerly Barnet Dulaney Perkins Eye Center)
• Cancer & Blood Specialists of Arizona (Gilbert, Phoenix)
• Ruth Eckert MD Personalized Care (Scottsdale)
• FYK MED Internal Medicine (Phoenix)
• InfuseAble Care (Goodyear, Scottsdale)
• Ocotillo Surgery Center (Gilbert)
• Pain Experts of Arizona (Gilbert, Goodyear)
• Scottsdale Skin Boutique and Dermatology (Scottsdale)
• Sol Valley Surgery Center (Chandler)
• SW Anesthesia (Phoenix)
• Team Select Mobile Physician Services (Valley-wide)
• Trinity Integrated Medicine (name change only; formerly Trinity Adult Medicine) (Phoenix)

You can also view a list of practices and providers no longer participating in ACN.