Case Study CCPM ACO in Administration and Health Policy ~ Health Policy And Administration

CHAPTER 1 INTRODUCTION

1.1 Background of the Paper

Twelve health care organizations across the state of Maine have partnered to form the Community Care Partnership of Maine – an Accountable Care Organization (CCPM ACO). Under an effort spearheaded by Saint Joseph Healthcare and Penobscot Community Health Care, the CCPM ACO has emerged as a community-focused, mission-based health care organization committed to improving the health of the communities they serve. Other ACO models in Maine are focused around major hospital systems or major health services corporations. The CCPM ACO model was developed to pilot a very different model based on robust joint ownership and control among community hospitals and community health centers. All these organizations, while working collaboratively with major health care systems, are committed to remain highly independent and focused on the needs of their particular communities – many of them rural.

The CCPM ACO partners include four community hospitals and eight Federally Qualified Health Centers. All are participating in a Maine Care Accountable Community initiative – which started August 1, 2015. CCPM ACO also became a Medicare Shared Savings Program ACO in January 2016. In addition, CCPM ACO is involved with shared savings ACO plans with three commercial payers in Maine. Altogether, CCPM ACO has over 60,000 covered patient lives in ACO-model shared savings plans; more are expected in next few years.

By working together, CCPM ACO member organizations will enhance the delivery of health care through meaningful shared learning on how to help deliver the most effective health care for its patients. They work together toward the Triple Aim – improve access to care, improve clinical outcomes, reduce costs and improve patient experience of care.

The underlying philosophy of CCPM ACO are full collaboration and joint and equal ownership of the ACO among all its members; commitment through finances and the extensive time of clinical and administrative leaders; common cultures as community-rooted organizations and as non-profit and mission-based organizations; access to quality and effective health care for the most vulnerable residents; independence, but collaborating with larger hospital systems and many other groups; nationally certified Patient Centered Medical Homes staffed with local care managers who serve patients with higher levels of chronic disease and high rates of ED or hospital readmissions; full utilization of the Maine Health Information Exchange – HealthInfoNet ; and distribution of shared savings to member organizations based on the number of their patients in the ACO program.

All partners have committed to membership criteria that include without limitation, which is being a not-for-profit legal entity; maintaining or achieving NCQA medical home recognition or its equivalent or, at a minimum, being in the process of submitting for NCQA or equivalent recognition within a reasonable period of time from the date of admission to the ACO; utilizing a meaningful use-certified electronic medical record in a manner that allows participation in population health management; providing effective practice-based care management; and having the capacity to generate and utilize population health data.

CCPM ACO strives to transform the delivery of health care by working together, through meaningful sharing and through accountability for the health of their patients by sharing information openly to achieve constant improvement in patient care, patient satisfaction, and efficient health care delivery. CCPM ACO shares decision-making equally among members, and establishes a governance structure that ensures full participation of all members in the decisions affecting them with one vote per member organization on all matters. CCPM ACO has three major and very active committees: Quality & Clinical Integration, Finance & Operations Committee, and Compliance. The Quality & Clinical Integration Committee is supported by four subcommittees: Data and Information Technology, Care Management, Medication Use, and Quality & Process Improvement.

As the two largest member organizations and both based in Bangor, St. Joseph’s Healthcare (SJH) and Penobscot Community Health Care (PCHC) have collaborated to consolidate quality departments and share resources to improve primary care and to achieve efficiencies across CCPM. Both of them are piloting some initiatives like predictive analytics tools, and clinical pharmacy supported through PCHC’s pharmacy residency program. After piloting, these and other strategies can be brought forward to other interested CCPM members.

The Patient Centered Medical Home (PCMH) is a way of organizing primary care emphasizing care coordination and communication to transform the way this service is delivered. A beneficiary is assigned to an ACO if the beneficiary receives at least one primary care service by a provider affiliated with that ACO. All physicians included in an FQHC attestation are considered primary care physicians. For FQHCs that are ACO participants, CMS considers a reported service to be primary care if the associated Healthcare Common Procedure Coding System (HCPCS) or revenue center code meets the definition of a primary care service and if a primary care physician is the attending provider reported on the claim.

Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care. NCQA PCMH Recognition is the most widely used way to transform primary care practices into medical homes. Although not a requirement of PCMH, most CCPM ACO members have integrated mental health services, and many of the community health centers have integrated dental services.

HealthInfoNet is the State of Maine’s health information exchange (HIE). A HIE is a secure, standardized electronic system where health care providers can share important patient information, giving them the tools they need to make more informed, data-driven treatment decisions. It was incorporated in 2006 and is governed by a board of directors and several committees run by Maine people serving on behalf of doctors, hospitals, public health, patients, and groups representing various consumer interests.

In 2013, Maine’s Department of Health and Human Services (MDHHS) was awarded one of six State Innovation Model (SIM) Testing Grants sponsored by the Centers of Medicare and Medicaid Services (CMS). The three-year grant with total funding of just over $33 million is used to help improve care and reduce health costs in Maine. Maine will focus its efforts on supporting current payment and delivery reform, using health information technology to better understand cost and quality and to further health reform efforts across Maine. HealthInfoNet is one of three sub-contractors to this grant. HealthInfoNet provides leadership support for the Maine SIM Data Infrastructure Subcommittee, which advises on activities related to the health information technology improvements.

CCPM ACO providers gather and report data from across the care continuum to help providers drive quality and cost improvements. As part of the SIM evaluation, a dashboard has been created that shows progress on core metrics. The data are further segmented by MaineCare, Medicare, and commercial patients, and includes metrics on things like non-emergent emergency department use, use of imaging studies for low back pain treatment, and developmental screenings for children in the first three years of life. Each metric shows whether the measure has made progress towards its goal.

The HIE analytics service then uses real-time clinical data to help providers drive quality and cost improvements, manage risk and population health and inform operational decision making. For example, a patient records an abnormal A1C risk score, which is relayed to a care manager who can then engage the patient within 24 hours after testing. Scoring guides are used to detect patients at highest risk for complications and are helpful for predicting readmissions. This level of analysis coordinates care management and risk to achieve savings and quality care.

HealthInfoNet has been selected by DASH – Data Across Sectors for Health – as one of 10 grantees to implement projects that improve health through multi-sector data sharing collaborations. DASH is a national program of the Robert Wood Johnson Foundation that identifies and tests innovative practices that foster collaboration, engages across sectors and builds robust data and information systems to increase capacity of organizations to improve health in their communities.

HealthInfoNet plans to incorporate electronic health record (EHR) data from members of the CCPM ACO utilizing the HIE’s real-time predictive analytics system. The integrated predictive analytics will allow the practice sites to identify patients needing care management and community support, and bring significantly greater collaboration among health care and social service agencies. Another innovation involves two community action programs (CAPs) that will start loading their social determinant data into the HIE record.

The MaineCare Accountable Community (AC) initiative program is Medicaid’s version of Accountable Care Organizations (ACOs) in Maine. The AC must include providers that directly deliver primary care services, as primary care practices are the main basis for assigning MaineCare members to the AC. Like the Medicare Shared Savings Program, groups of providers can share in savings for an assigned population, with the savings payments directly tied to the ACs score on a range of quality measures.

Under the program, the MDHHS entered a three-year AC contract with the AC “Lead Entity.” The Lead Entity, CCPM ACO in this case, represents the providers that comprise the AC. The program offers broad flexibility of provider types allowed to be part of the AC and the AC operational structure. CCPM ACO currently provides ACO shared savings support for about 60,000 patient lives – and since member organizations provide similar care management and other support services to all patients regardless of pay class, the number of covered lives is actually much higher.

1.2 Problem Formulation

1. What is the summary of the case above, especially about the issue of the administration and policy scope?

2. What is the main foundation that determines the success or failure of the organization development?

3. What is the determine CSF (Critical Success Factors) for solution of the case?

4. What is the relevance of the community care partnership application with the effort for increasing organization effectiveness and efficiency?

5. What is the complete scheme of the case above, based on management system concept?

CHAPTER 2
DISCUSSION

2.1 Administration and policy review of CCPM-ACO

The U.S. health insurance system is a mixed system where public health insurance programs are limited to the retired population (Medicare) and the poor (Medicaid) while the majority of working individuals obtain private health insurance via their employers.

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. Health provider in U.S mostly is ACO. The ACO is accountable to patients and third-party payers for the quality, appropriateness and efficiency of its services. The various providers within an ACO work to provide coordinated care, align incentives and lower costs.

In Maine, twelve health care organizations across the state have partnered to form the Community Care Partnership of Maine – an Accountable Care Organization (CCPM ACO). CCPM ACO are focused around major hospital systems or major health services corporations yet committed to remain highly independent and focused on the needs of their particular communities – many of them rural.

1. Policy review

All partners have committed to membership criteria that become basic policy for the members :

a. Being a not-for-profit legal entity

b. Maintaining or achieving NCQA medical home recognition or its equivalent or, at a minimum, being in the process of submitting for NCQA or equivalent recognition within a reasonable period of time from the date of admission to the ACO

c. Utilizing a meaningful use-certified electronic medical record in a manner that allows participation in population health management

d. Providing effective practice-based care management

e. Having the capacity to generate and utilize population health data Based on that criteria, CCPM-ACO makes policy that impacts to all members of it.

Although individually they have an institutional policy, but as the organization member they should follow the organization's policy.

2. Administration review

a. Governance and leadership structure of CCPM-ACO

CCPM-ACO shares decision-making equally among members, and establishes a governance structure that ensures full participation of all members in the decisions affecting them with one vote per member organization on all matters. Holding leaders, providers and each other accountable to explicit expectations of the ACO once those expectations are agreed upon by the group.

CCPM ACO has three major and very active committees: Quality & Clinical Integration; Finance & Operations Committee; and Compliance. As the two largest member organizations, St. Joseph’s Healthcare (SJH) and Penobscot Community Health Care (PCHC) have collaborated to consolidate quality departments and share resources to improve primary care and to achieve efficiencies across CCPM. Both of them are piloting some initiatives like predictive analytics tools, and clinical pharmacy supported through PCHC’s pharmacy residency program. After piloting, these and other strategies can be brought forward to other interested CCPM members. This model is a kind of knowledge management practice.

Scarborough et al (1999) define knowledge management as any process or practice of creating, acquiring, capturing, sharing and using knowledge, wherever it resides, to enhance learning and performance in organizations. One of many tools for improving organizational effectiveness is developing policies in such areas as knowledge management (Armstorng, 2006).

b. CCPM as a nonprofit organization

CCPM has founded by 12 health providers which concern about providing a better access and service to particular communities in Maine many of them rural that it will improve the health of communities they serve. Nonprofit organization is an organization whose primary purpose is anything other than to make a profit (or, more precisely, to create wealth for itsowners). Its primary purpose is typically to provide some kind of public service. Included in the non-profit category are governmental organizations and their various institutions, authorities, agencies, and programs. Also included are a large number of private organizations operated for public benefit.

Many nonprofit organizations earn revenues by selling services or products. However, money (that is, cash flows and surpluses of revenues over expenses) is only a constraint. It is not an overriding goal. Some entities within nonprofit organizations do have goals to earn profits. However, profit is not their parent rganization’s primary purpose. Whatever profits are earned in the entities are used to further the organizations’ overriding goals. All the resources they acquire must be used to further the organizations’ primary purposes. CCPM ACO has three main aim ;

1) Improve access to care

2) Improve clinical outcomes

3) Reduce costs and improve patient experience of care.

The underlying philosophy of CCPM ACO is:

1) Full collaboration and joint and equal ownership of the ACO among all its members.

2) Commitment through finances and the extensive time of clinical and administrative leaders.

3) Common cultures as community-rooted organizations and as non-profit and mission-based organizations.

4) Access to quality and effective health care for the most vulnerable residents.

5) Independence, but collaborating with larger hospital systems and many other groups.

6) Nationally certified Patient Centered Medical Homes staffed with local care managers who serve patients with higher levels of chronic disease and high rates of ED or hospital readmissions.

7) Full utilization of the Maine Health Information Exchange – HealthInfoNet.

8) Distribution of shared savings to member organizations based on the number of their patients in the ACO program.

c. Organizational learning in CCPM-ACO

Organizations learn only through individuals who learn. Individual learning does not guarantee organizational learning. But without it, organizational learning won’t occurs. CCMPM-ACO consist of 12 health providers that always works as a “single” system as well as a “team” system to provide health care. A member who has a better system or practice will manage to shares among CCPM-ACO members.

CCPM-ACO shares openly best practices and internal systems and creates new shared systems with the goal of delivery system transformation. CCPM-ACO members participate actively in a strong team committed to supporting and learning from each other, and devote the time necessary, among senior leaders and staff of member organizations, to accomplish shared initiative. CCPM-ACO members are challenging the status quo to change the way healthcare is delivered, and challenge each other to take on bold initiatives in providing a better health care service.

d. Health Information System

ACO or accountable care organization is a system where a doctors, health care providers and hospitals provide and use medical history and patients data to provide better health service. CCPM follow ACO system that means the health providers share among them all about patients medical history record to help improve how they provide care.

They work collaboratively and share information openly to achieve constant improvement in patient care, patient satisfaction and efficient healthcare delivery. For example, doctors who join ACO will get patient’s medical information from Medicare or private health insurance to help them to know patient’s medical history, including patient’s medical conditions, prescriptions, and visits to the doctor, and give patien the right care at the right time in the right setting. Health analytics is a business driven term that encompasses a wide spectrum of aspects and dimensions of business intelligence applications and big data analysis. This new concept is based mainly on the availability and accessibility of data and information pooled through the good integration and interoperability of a wide range of systems and tools such as hospital information systems, electronic medical records, clinical decision support systems, and other specialized medical sys-tems.

Full utilization of the Maine Health Information Exchange – HealthInfoNet by health care providers can share important patient information, giving them the tools they need to make more informed, data driven treatment decisions. The HIE analytics service then uses real-time clinical data to help providers drive quality and cost improvements, manage risk and population health and inform operational decision making. Efforts to incorporate HIE tools into healthcare delivery will be most successful when technologies are developed in the context of effective models of health service delivery that foster successful relationships between patients and health providers.

e. Funding system

CCPM-ACO works together with national health insurance Medicaid, Maine Care and several commercial payers. Medicare is the ACOs primary payer. Other payers include private insurances and employer-purchased insurance. Payers may play several roles in helping ACOs achieve higher quality care and lower expenditures. Payers may collaborate with one another to align incentives for ACOs and create financial incentives for providers to improve healthcare quality. Distribution of shared savings to member organizations based on the number of their patients in the ACO program

ACO’s place financial responsibility on providers in hopes of improving care management and limiting unnecessary expenditures, while providing patients freedom to select their medical service providers. ACO's model of fostering clinical excellence while simultaneously controlling costs depends on its ability to "incentivize hospitals, physicians, post-acute care facilities, and other providers involved to form linkages and facilitate coordination of care delivery.

By increasing care coordination, ACO’s were proposed to reduce unnecessary medical care and improve health outcomes, reducing utilization of acute care services. Payments linked to quality improvements and reduced costs.

f. Human resources management

One of philosophy CCPM-ACO is an access to quality and effective health care for the most vulnerable residents. Quality and effective health care depend on the quality of human resources of CCPM-ACO. CCPM Nationally certified Patient Centered Medical Homes staffed with local care managers who serve patients with higher levels of chronic disease and high rates of ED or hospital readmissions.

Staffs of CCPM also have to understand and use the health system information management as a tool to deliver a better quality and effective care to the patient. They can view patient medical history and give service for the patient with right diagnosis and treatment. Members of CCPM share information widely so they can learn from each other about health care. It also call as knowledge management. Shared best practice information between members of CCPM will also directly improve their skill.

2.2 The Main Foundation of the Organization Development Organisation

Development is a generic term embracing a wide range of intervention strategies into the social processes of an organisation. These intervention strategies are aimed at the development of individuals, groups and the organisation as a total system. In a very general sense, organisation development is concerned with attempts to improve the overall performance and effectiveness of an organisation (Mullins, 2007).

Change is a natural and inevitable process. There are shades of grey in between unplanned and planned change. An unplanned change is often responded to by taking ad hoc measures that are drawn out of the ways that an organization has been successfully employing in the past. The outcome may be effective or ineffective, but it does lead to hindsight for future actions. Similarly, a change programme no matter how meticulously planned may leave a few loose ends or spring an unanticipated outcome that is indeed an unplanned change. Another way to look at change is its source that can be either internal or external to an organization or a mix of both.

Planned changes result in organizational development. Organizations plan to change partly because of internal compulsions arising primarily out of a serious lack of fit between their goals, structures, and functions and partly by way of managing their interface with the surrounding socio-economic-political, technological, and other environmental pressures.

CCPM ACO is an organization that is still under development. CCPM ACO has emerged as a community-focused, mission-based health care organization committed to improving the health of the communities they serve. By working together with 12 health care organizations, several challenges should be overcome by them. CCPM aco will always experienced a changes that are influenced by external pressures such as socio-economic, state policy, and so forth. Development of the organization will be successful if organization can aligning organizational development with business strategy. Successful organization development is determined by the result of organizational development programs.

1) They were managed, or at least strongly supported, from the top but often made use of third parties or ‘change agents’ to diagnose problems and to manage change by various kinds of planned activity or ‘intervention’. CCPM ACO shares decision-making equally among members and establishes a governance structure that ensures full participation of all members in the decisions prove that they were managed well and ready to develop. Their readiness was supported by the three-year grant with total funding of just over $33 million. It is used to help improve care and reduce health costs in Maine.

2) The plans for organization development were based upon a systematic analysis and diagnosis of the circumstances of the organization and the changes and problems affecting it. CCPM ACO providers gather and report data from across the care continuum to help providers drive quality and cost improvements. As part of the SIM evaluation, a dashboard has been created that shows progress on core metrics. These prove that CCPM ACO has systematic analysis and diagnosis of the circumstances organization, changes, and problems. These are the base of planning of organization development of CCPM ACO. In addition, another innovation involves two community action programs (CAPs) that will start loading their social determinant data into the HIE record. These are the kind of organization development plans by systematic analysis. On the other side, HealthInfoNet plans to incorporate electronic health record (EHR) data from members of the CCPM ACO utilizing the HIE’s real-time predictive analytics system. The integrated predictive analytics will allow the practice sites to identify patients needing care management and community support, and bring significantly greater collaboration among health care and social service agencies. Another innovation involves two community action programs (CAPs) that will start loading their social determinant data into the HIE record.

3) They used behavioral science knowledge and aimed to improve the way the organization copes in times of change through such processes as interaction, communications, participation, planning and conflict. Processes as interaction, communications, participation, planning, and conflict had been through by CCPM ACO member. As the two largest member organizations and both based in Bangor, St. Joseph’s Healthcare and Penobscot Community Health Care are piloting some initiatives like predictive analytics tools, and clinical pharmacy supported through PCHC’s pharmacy residency program. After piloting, these and other strategies can be brought forward to other interested CCPM members. The whole process, since piloting until delivered initiatives, are the cycle of process to improve the way the organization copes in times of change.

Organizational development is action-oriented and tailored to suit specific needs. It takes a number of forms with varying levels of intervention. Organizational development concerns itself with the examination of organizational health and the implementation of planned change. This may include training in interpersonal skills, sensitivity training, and methods and techniques relating to motivational processes, patterns of communication, styles of leadership and managerial behaviour.

2.3 CCPM-ACO’s Critical Success Factor

The critical success factors are areas of activity that should receive constant and careful attention from management . A broader description of CSFs explains, “The Critical Success Factor (CSF) concept is a formal process of establishing and maintaining corporate priorities (Crandall & Crandall, 2008). CSFs are internal or external events or possible events that can affect the firm either positively or negatively and thus require special attention. CSFs provide an early warning system for management and a way to avoid surprises or missed opportunities.

Although an organization can accomplish a vast agenda of activities, not all of those accomplishments are necessary for the success of the business. CSF or critical success factor is an element of organizational activity which is central to its future success.

Some CSF result from an examination of a business’s internal strengths or weaknesses — the development of closer supply chain relationships or the need to extend the employee empowerment program. Some CSF may change over time. They become part of the dynamic plans of the business and may include items such as product quality, employee attitudes, manufacturing flexibility, and brand awareness. This can enable analysis.

CSF’s change over time. They change over a product’s life cycle. CCPM-ACO is a newly formed organization. If associated with the product life cycle, the position of CCPM aco is currently in a growth position. In this position, an organization like CCPM-ACO should have a critical success factor that focus on quality availabilty. Critical success factor in this organization can be defined

1. HIE data validity

Efective services could only delivered if supported with valid data. HIE play importan role here that make it as a critical success factor. Using HIE, health care providers can share important patient information, giving them the tools they need to make more informed, data-driven treatment decisions. Validity of HIE data really important that minimize any unnecessary or error inside the database.

2. Health care quality

Became one of the basic philosophy of the organization which provides quality access to health services is a critical succes factor for the organization. CCPM-ACO's staffs have nationally certified “Patient Centered Medical Homes” with local care managers who serve patients with higher levels of chronic disease and high rates of ED or hospital readmissions.

CCPM really ensure that their members have criteria at a minimum, being in the process of submitting for NCQA. NCQA Patient-Centered Medical Home Recognition is the most widely used way to transform primary care practices into medical homes. Although not a requirement of PCMH, most CCPM ACO members have integrated mental health services, and many of the community health centers have integrated dental services.

3. Inter-organizational communication

Collaboration between 12 health care providers will make a hard task if there isn’t a good communication within members. Inter-organizational communication become important in daily operational. By working together, CCPM ACO strives to transform the delivery of health care through meaningful sharing, and through accountability for the health of their patients by sharing information openly to achieve constant improvement in patient care, patient satisfaction and efficient health care delivery. CCPM ACO shares decision-making equally among members, and establishes a governance structure that ensures full participation of all members in the decisions affecting them with one vote per member organization on all matters.

Without good intra-organizational communication, there won’t any knowledge management transferred from a pilot project provider to other members. As example, St. Joseph’s Healthcare (SJH) and Penobscot Community Health Care (PCHC) have collaborated to consolidate quality departments and share resources to improve primary care and to achieve efficiencies across CCPM. As the two largest member organizations and both based in Bangor, SJH and PCHC are piloting some initiatives like predictive analytics tools, and clinical pharmacy supported through PCHC’s pharmacy residency program. After piloting, these and other strategies can be brought forward to other interested CCPM members.

4. Efficiency and efectivity organization

The last one, efficiency and effectivity organization will always be a CSF in any organization. Providing effective practice base care management with supported by valid data about the patient's medical record will improve patient’s experience of care. Effective care will directly influence on the organization’s efficiency. Treating the patient with the right diagnosis, right care and the right time will ensure effectivity of health care service.

Many organization has to cut the operational cost that can save money and increase the organization’s efficiency. CCPM-ACO has a better way to achieve it by providing an effective healthcare ( doing the right things) to reduce any unnecessary points that the cost can be pressured in a good way.

2.4 Relevance Community Care Partnership with the Efective and Efficiency Organization

Service bussiness like hospital or health care are looking for ways to operate more efficiently and effectively. Health care providers are looking for ways to cut costs and improve quality as well. Rising health care costs are of concern to leaders in business and government as well as the individual consumer. Everyone wants improved health care however not everyone is able to pay for it. Medicare, medicaid and private insurance give an option for patient who can’t afford to pay health care cost. This situation is smartly seen by CCPM-ACO to run community care partnership supporting communities in Maine to get an access and better health care.

CCPM ACO is involved with shared savings ACO plans with three commercial payers in Maine. By working together, CCPM ACO member organizations will enhance the delivery of health care through meaningful shared learning on how to help deliver the most effective health care for its patients.

Health services through insurance payments, involving third parties such as service providers, insurers, and patients. Users paid a premium imposed on the insurer. The service provider will receive payment from insurers through a payment system that has been approved. With payments received from insurers, service providers must be able to manage finances well so that they can operate as efficiently and effectively as possible with health care management standards that have been determined by the organization.

By participating in the organization CCPM ACO, the tariff services to health care providers should be equated with the tariff agreed between insurers and health care providers. Through this system, the health service is expected to become more efficient and effective without reducing the quality of the service itself. It is clearly that there is relevance between community care partnership with the efective and efficiency organization. Members of CCMP-ACO will ensure giving the effective services to cut unnecessary step or program that it directly impacts on the efficiency of the organization 2.5 A Complete Scheme of CCPM ACO in Management System Concept CCPM ACO as an organization should has a management system that framed like scheme below.

Management Process

a. Planning Community-focused, mission-based health care organization

b. Organizing Full collaboration and joint and equal ownership of the ACO among all its members.

c. Staffing CCPM ACO has three major committees: Quality & Clinical Integration, Finance & Operations Committee, and Compliance. The Quality & Clinical Integration Committee is supported by four subcommittees: Data and Information Technology, Care Management, Medication Use, and Quality & Process Improvement.

d. Directing The patient-centered medical home (PCMH)

e. Coordinating CCPM ACO shares decision-making equally among members, and establishes a governance structure that ensures full participation of all members.

f. Reporting CCPM ACO providers gather and report data from across the care continuum to help providers drive quality and cost improvements.

g. Budgeting Distribution of shared savings to member organizations based on the number of their patients in the ACO program.

CHAPTER 3

CONCLUSION

3.1 Conclusion

CCPM ACO in Maine has created a model of delivery and coverage that is unique in its collaboration of provider types and principles. Collaboration between community hospitals and FQHCs has extended coverage across the state, providing access to quality primary care through the CCPM ACO. Safeguarding independence with joint and equal ownership ensures accountability to the group and ultimately to the member subscribers, as well as vests each organization in the ACO’s outcomes.

Emphasis on PCMH and care management underscores the importance of standardization and quality across all 12 partners. Medical homes can lead to higher quality and lower costs and can improve patients’ and providers’ experience of care. The ACO has great potential to improve population health through the HIE. The HIE analytics service uses real-time clinical data to help providers drive quality and cost improvements, manage risk and population health and inform operational decision making. CCPM ACO has gathered experience through participation in MaineCare, Medicare and a number of commercial payers. CCPM ACO has a plan to extend the number of patient’s that covered with their program.

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