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ACN Advance - January 2020

ACN PCPs Receive $3 Million in Gainshare for 2018 Performance

Increased Funding, Fewer Reporting Burdens Highlight 2020 PRP Changes

ACN Website en Español

Mandatory CMS Info Being Mailed to Medicare Patients

GPRO Audit Underway for 2020

QPM Approves Changes to Chronic Kidney Disease Program

News Roundup

New Provider Organizations

New Year, New Opportunities

Our strategic pillars form a foundation for new opportunities to improve our physician-driven, clinically-integrated network: • Expand and empower our loyal, engaged network • Strengthen our relationships with Arizona payers and employers through value-based contracts • Innovate to improve care, reduce costs and eliminate administrative burdens • Enhance ACN’s foothold as one of Arizona’s leading ACOs and as a dynamic network of primary care and specialist providers • Keep the best interests of our patients at the center of everything we do

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Healthy Population is our new base pillar. As with any structure, this base represents our foundation which supports the growth of the other five pillars. Just as a solid base anchors a solid structure, a healthy population anchors a stronger Arizona. Your feedback is always welcome as we continually seek ways to improve the effectiveness and efficiency of our network in 2020 and beyond. Please reach out to me or your Clinical Performance Consultant with any questions or ideas for improvement. As always, our Care Coordination team is ready to support your patient care with resources and services for your patients. We wish you a healthy, happy and successful 2020 for your practice and patients. Sincerely, Todd Ricotta CEO (interim) Executive Director, Provider Network & Government Relations

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ACN Primary Care Providers Receive $3 Million in Gainshare for 2018 Performance

The Centers for Medicare and Medicaid Services (CMS) recently released the 2018 results for Medicare’s Next Generation Accountable Care Organization (NGACO) Model. ACN’s NGACO providers saved CMS nearly $5.38 million by focusing on quality and in-network care coordination initiatives for approximately 25,000 Medicare beneficiaries in 2018. This represents a 418 percent increase in total medical cost savings over 2017. CMS shares a percentage of those savings with ACN. Per your Board of Managers policy, we distributed more than $3 million in total CMS gainshare to 150 practices in December. Gainshare Only One of Many ACN Benefits Gainshare distributions are a well-deserved yearlong reward for your practice’s dedication, hard work, and proactive approach toward coordinated patient care. But the financial incentives for participating in our NGACO is only one of many year-round benefits, including:

If you have questions or feedback, please speak with your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org.

Significant changes are coming to the Provider Rewards Program in 2020 for eligible primary care practices. Thanks to your feedback, the Board of Managers approved several alterations aimed at simplifying the PRP’s design, reducing administrative burdens, and significantly increasing the available incentive pool. The approved updates include:

  • Increasing total available incentive pool from $2 million to $7 million
  • Adjusting benchmarks quarterly based on previous TIN results to increase potential financial opportunities for improved performance as well as sustained high-level performance
  • Reducing total performance metrics from 10 to three
  • Increasing available points for those three metrics:
    • Performing a hemoglobin A1c test (now 25 points)
    • In-Network Care Coordination metric (now 50 points)
    • Transitional Care for patients seen within 14 days following acute care event (now 25 points)
  • Adding an incentive of $100 for an eligible Annual Wellness Visit with a Medicare patient
  • Maintaining high-risk Medicare patient visits with a PCP at $50 per visit per quarter
  • Publishing Quality Gap Reports to the Secure Provider Portal each month by your CPC
  • Eliminating manual data entries through Athena

A confidential, printable overview of the 2020 PRP changes is available on the Secure Provider Portal or from your Clinical Performance Consultant. Please contact your Clinical Performance Consultant with any questions or feedback you may have about PRP changes in 2020, or email practicetransformation@azcarenetwork.org.

AZCareNetwork.org Coming Soon in Spanish

AZCareNetwork.org visitors will soon have the option to view the site in Spanish. All primary pages within the site were translated with help from people well-versed in healthcare and insurance, localized for Arizona’s Spanish-language speakers. This includes the Patient, Providers, Employers, and Insurance sections. The MyAZDoc app will also be available in Spanish. Content specifically tailored toward Medicare patients has been translated, including Resource blogs within the site. Eventually all site content is expected to be translated and viewable in Spanish in 2020. Additionally, the Care Coordination Concierge line (602.406.7226) includes Spanish speakers to help improve member access and communication within our community.

Mandatory CMS Information Being Mailed to Medicare Patients

The Centers for Medicare & Medicaid Services (CMS) requires accountable care organizations to mail an annual notification letter to all Medicare beneficiaries attributed to the network. More than 35,000 Medicare lives under ACN’s Next Generation ACO model are expected to receive a letter by March 15. The letter will notify beneficiaries that their primary care doctor participates in Arizona Care Network. The letter also lists the benefits and special programs available to beneficiaries at no additional cost. This includes care coordination, home visits, concierge services, and more. We will also upload the letter to the Provider Portal once CMS approval is confirmed. In addition to the notification letter, CMS allows ACN to include custom materials for patients. In this year’s mailing, we are including:

  • ACN Preferred Providers directory
  • Care Coordination and concierge information
  • Care Coordination “Success Story”

For questions or more information, please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org.

Each year, ACN must report on the CMS Quality Measures for practices that participate in Next Generation ACO. We report these measures to CMS through an audit called the Group Practice Reporting Option (GPRO). The audit runs from January through March. For clinicians who participated in a Medicare ACO in 2019, the GPRO audit fulfills your MIPS Quality Reporting requirement. The audit also impacts ACN’s gainshare opportunity for the 2019 reporting year. We take the audit very seriously and commit extensive ACN resources to ensure successful reporting. ACN makes every effort to abstract data with minimal disruption to your office staff. Here are a few things to consider as we enter the auditing process. Flexibility If you elect an onsite audit, the GPRO support team will schedule a date and time between January and March. We do everything possible to keep to that schedule but may need to adjust based on how the data collection process progresses at each location. Remote EMR Access Remote EMR access allows for faster, more efficient data abstraction. Access is at an “audit” level only, with no ability to input or change data in the EMR. All EMRs have audit roles available for provisioning. If you have any questions, please contact provisioning@azcarenetwork.org. Identify a Point of Contact We’ve found that having a designated point of contact to work with minimizes office staff disruption. If you haven’t already done so, please help us identify the best point of contact for your ACN Data Abstractor. As always, ACN greatly appreciates your cooperation. If you have any questions about the GPRO audit, please contact quality@azcarenetwork.org.

QPM Approves Early Referral Changes to Chronic Kidney Disease Program

Jason Kwan, PharmD ACN Population Health Pharmacist The Early Referral Chronic Kidney Disease Program was recently approved by the ACN Quality Performance Management Committee and the ACN Board of Managers. Early referrals are generally defined as a time period of three months or longer between a PCP referral and a patient’s visit with a nephrologist. This longer period of advanced notice can improve outcomes by delaying the need to initiate renal replacement therapy, reduce hospital length of stay and costs, increase use of peritoneal dialysis, and a reduced mortality rate.1,2 A late referral is generally defined as three months or less in referral time between a PCP referral and a patient’s visit with a nephrologist to prepare patients for renal replacement therapy. A systematic review of 27 longitudinal studies on 17,646 study participants found a 12% reduction in overall mortality in patients with an early referral. Hospitalization was also found to be 8.8 days shorter with an early referral.1 Another study found the mean total costs per patient per year with an early referral was $17,554, compared with $22,011 for those with a late referral.3 Primary care providers are essential to care coordination and referral to a nephrologist for patients with chronic kidney disease (CKD). Per the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, a primary care physician should initiate a referral to a nephrologist when one or more of the following criteria occurs, regardless of CKD staging:4

  • Acute Kidney Injury or abrupt sustained fall in Glomerular Filtration Rate (GFR)
  • GFR <30 ml/min/1.73 m2 (CKD stage 4 and 5)
  • Consistent finding of significant albuminuria (Albumin-to-creatinine ratio >=300 mg/g [>=30 mg/mmol]
  • Progression of CKD (25% or greater drop in eGFR from baseline or sustained decline in eGFR of more than 5 ml/min/1.73 m2/year)
  • Urinary red cell casts, RBC > 20 per high power field sustained and not readily explained
  • CKD and hypertension refractory to treatment with 4 or more antihypertensive agents
  • Persistent abnormalities of serum potassium
  • Recurrent or extensive nephrolithiasis
  • Hereditary kidney disease

ACN will provide patient rosters of those who meet these criteria during the first six months of the program’s rollout. Your Care Coordination team is also available to assist with in-network referrals and other resources for this patient population. Providers or patients may call 480.406.7226. Please contact your Clinical Performance Consultant with any questions or email practicetransformation@azcarenetwork.org. Sources:

  • Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H. Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med. 2007;120:1063-1070.46.
  • Kinchen KS, Sadler J, Fink N, et al. The timing of specialist evaluation in chronic kidney disease and mortality. Ann InternMed. 2002;137:479-486.
  • McLaughlin K, Manns B, Culleton B et al. An economic evaluation of early versus late referral of patients with progressive renal insufficiency. Am J Kidney Dis 2001; 38: 1122–1128.
  • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3: 1-150.
  • During the December Board of Managers meeting, five current ACN Board of Manager members were re-elected to three-year terms, beginning in January:
    • Linda Brown, MD, Abrazo Medical Group
    • Jon Hackenyos, DO, Ocotillo Internal Medicine Associates
    • Michael Newcomb, MD, ASAP Health Solutions
    • Dana Seltzer, MD, AZ Sports Clinic
    • Ed Tokatlian, MD, Associated Internists of Ahwatukee
  • Additionally, the ACN Board of Managers approved voting member positions for three physicians during its December meeting:
    • Tiffany Nunnelley, DO, was approved as a new member of the Board of Managers. Dr. Nunnelley has been with Abrazo Medical Group in Scottsdale since 2009. She previously served three years as chief resident with Phoenix Baptist Hospital. “I think the ACN does a great job of bringing specialists and primary care (physicians) together,” she said. “It also helps reduce the cost of care for patients. I wanted to be on the board of managers to help bring new ideas to the board and help bring my opinions as a family doctor.”
  • Rajeev Garg, MD, a cardiologist with Heart One Associates in Peoria, was approved as a voting member of the Network Development Committee.
  • Rajal Mehta, MD, a primary care provider with IMS in Phoenix, was approved as a voting member of the Quality & Performance Management Committee. Dr. Mehta specializes in geriatric and internal medicine.

Welcome, New Provider Organizations!

AZ-Tech Radiology (Ahwatukee, Apache Junction, Casa Grande, Gilbert, Maricopa, Mesa, Phoenix, Tempe) Arizona Surgery Center (Scottsdale) CHAMP Physical Therapy and Pilates (Chandler) Chicanos Por Las Causa (Phoenix) Compassionate Surgical Associates (Chandler) East Valley Urology Center (Mesa)

Foothills Neurology (Phoenix) General & Robotic Surgical Associates (Scottsdale) Multi-Specialty Physicians (Surprise) Ocotillo Foot and Ankle Centers (Chandler) Valley GI Consultants (Glendale) Virtis Health (Tempe)

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