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How one health system closed care gaps and achieved improved ACO scores

Wednesday, September 27, 2017

As accountable care organizations (ACOs) for the Medicare Shared Savings Program (MSSP) know all too well, just one instance of a patient missing a follow-up visit to a clinic can change that person’s risk score. And those scores are ultimately important for demonstrating the MSSP goals of increasing quality of care while decreasing costs.


Cincinnati-based Mercy Health Select faced that challenge head on. Already one of the top ACOs in the US, Mercy Health Select wanted to do even more to close gaps in care and potentially improve the system’s ACO scores. Better scores would mean better care for patients and could help the system earn greater shared savings from the MSSP affiliation, too.

First, tackling a common issue: Different EHR systems

The Mercy Health organization started with a typical challenge for ACOs: Not all of the affiliated physicians in the network used the same electronic health record (EHR) system. That made it difficult to quickly consolidate information about at-risk patients across facilities.

That’s why Mercy Health Select opted to leverage technology that allowed the system to combine and mine the disparate sources of both clinical and claims data. The platform they chose also ran analytics on the data — to identify and prioritize the most at-risk, high-cost patients for follow-up communications.

Then, solving for speed

Of course, the timeframe for producing this kind of information is critical, too. If care coordinators wait too long to reach out to an at-risk patient who has not had a recommended cancer screening, for example, the ability to impact the individual’s health decreases.

So Mercy Health Select again used technology to update EHRs and patient risk scores within 24 hours. The new structure means clinicians can click on a link in a patient’s chart and see gaps in care right away — fueling fast intervention when necessary.

Solidifying the connection

Implementation of the new approach is paying off for Mercy’s ACO. With more gaps in care closed and more at-risk patients likely on the road to better health, the organization boosted its ACO score to 97.1 percent. That score is nearly 6 percent higher than the average1, and something all ACOs may aspire to achieve. After all, with that kind of improvement in score and patient care, ACOs are setting themselves up to earn greater shared savings.

If you’d like more information on how the health system achieved this result, . You can also read the full case study .

1 Muhlestein D, McClellan M, Saunders R. (2016, September 9) Medicare Accountable Care Organization Results For 2015: The Journey to Better Quality and Lower Costs Continues [Blog Post], retrieved from target="_blank"