This Next Gen ACO relies on data investments to help track COVID-19 hot spots. Here's how

Coronavirus
The novel coronavirus has caused a wave of patients to hold off on getting medical care. This leads to uncertainty for Next Gen ACOs like Southwestern Health Resources. (Gettys)

Southwestern Health Resources Accountable Care Network, a major healthcare system in Texas, made a large investment in data collection and analysis as part of its participation in the Next Generation Accountable Care Organization program.

That investment is now helping the system learn more about the spread of COVID-19 in its region.

“We work with provider network to try to figure out where are the opportunities for us to help in the community and our membership,” said Danny Irland, Southwestern’s senior vice president of network operations and chief network officer, in an interview with Fierce Healthcare.

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The system, which has about 29 hospitals and 4,400 physicians, has been in the Next Gen ACO program since 2017 and has been an ACO in the Medicare Shared Savings Program (MSSP) since 2014.

The Next Gen ACO, which requires organizations to take on more financial risk than a regular ACO, has generated the most shared savings out of any participants in the program for two years, generating more than $67 million in savings from 2017 and 2018.

A major reason has been its use of claims data gleaned from its provider peers, which are in regional or geographically aligned pods that meet together monthly.

“We get the claims data every month,” Irland said.

The system uses that information to produce reports for physicians on healthcare claims and costs such as seasonal adjustments.

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Southwestern also consolidated the electronic medical record (EMR) systems providers use to provide consistency across such a wide system.

“The vast majority of our primary care physicians are on one of three EMRs,” Irland said. But initially, they were on one of 43 systems.

Danny Irland

“Those are deep investments and commitments to data homogenization to compare things across the ACO on a like basis so that you are comparing apples to apples,” he said.

That investment is helping the system combat the COVID-19 pandemic, which has wreaked havoc in healthcare systems across the country.

“We capture and track a tremendous amount of data on the 700,000 members we manage,” Irland said. “That isn’t just claims data, that is EMR data.”

The system used its data to identify pockets within its community that are “far and away exceeding COVID-19 infection rates than the market in general,” he added. The system then tried to get a “lot of educational materials out to folks in those areas.”

“We are able to take a mountain of data and distill it into very useful information for [physicians] that they wouldn’t otherwise have,” Irland said.

A 'very cloudy' future

Southwestern also has not been immune to the financial repercussions of the COVID-19 pandemic. It has seen a major drop in patient volume and a loss of revenue from the cancellation of elective procedures along with many systems across the country.

This has meant a delay or deferral of needed care for patients.

“The amount of care for the reasons we described is way off its normal pace,” Irland said. “From a risk-taking entity perspective that would tend to suggest there is going to be less medical cost expenditures against your benchmark target.”

However, the system is bracing for a wave of deferred care to come at some point as hospitals start to resume surgical procedures and patients head back to the doctor’s office.

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But they have no idea when exactly that wave is going to come and how that increase in medical costs will affect the benchmark, which is the cost target ACOs must meet to get financial savings. If an ACO goes over the benchmark, it must repay Medicare for any losses.

Irland said the wave of deferred care could impact the benchmark for 2021, but there are a lot of unknowns at this point.

“It becomes very cloudy in terms of what the longer-term impact could be for risk-bearing entities,” he said.

The future of the Next Gen ACO program was also very cloudy. The program, which requires ACOs to take on more financial risk than MSSP, was going to sunset at the end of 2020.

However, CMS decided to extend the program through 2021. It also will reduce the shared losses for Next Gen ACOs this year during the months of the COVID-19 public health emergency period.

“We were pleased they extended the program. We think that was the right move,” Irland said.

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