Accountable Care Organization
CHRISTUS Health operates an accountable care organization (ACO) called the CHRISTUS Health Quality Care Alliance (CHQCA). We contract with CMS in the Medicare Shared Savings Program (MSSP) to care for traditional Medicare patients and improve quality and reduce unnecessary spending. CHQCA is a large network of clinical partners dedicated to achieving the triple aim of healthcare: better health, better care, smarter spending.
What is an Accountable Care Organization (ACO)?
An accountable care organization (ACO) is a network of hospitals, clinicians, and community partners that come together and take responsibility for the overall cost and quality outcomes of traditional Medicare patients. ACOs are rewarded through shared savings bonuses from the CMS.
Why should an independent practice join CHQCA?
The Medicare Shared Savings Program requires at least 5,000 patients. CHQCA has 1,800 clinical network partners who care for 63,000 patients across Texas, Louisiana, Arkansas, and New Mexico. CHQCA's dedicated team provides support and expertise to ensure our network partners succeed. The ACO updates network partners on regulatory changes from CMS, share actionable reports and insights and provide data analytic tools. Our centralized team of care coordinators, nurse navigators, and risk adjustment coders work alongside your practice in a team-based approach. This helps improve outcomes and reduce unnecessary costs for patients.
- Our care coordinators outreaches to various patients to close the care gap and schedule preventative services
- Our nurse navigators identify, outreach, and support high-risk patients to lower ED utilization
- We partner with community-based resources to help address social determinants of health
- Our risk adjustment coders help practices capture chronic conditions to reflect the acuity of your patients, so the ACO has an appropriate budget to care for patients
What are the financial risks to joining?
There are no fees to join CHQCA and we have a strong history of success. The CHQCA has participated in the Medicare Shared Savings Program since 2016 and has a proven track record of increasing savings for CMS. The ACO has received bonuses since 2017, which are shared with our network partners that are based on the practice’s overall performance and panel size. Financial Performance of CHQCA:
|MSS (ACO) Shared Savings||2017||2018||2019|
|Total Amount Saved for CMS||$14,905,000||$21,624,000||$24,629,000|
|Total Shared Savings Earned||$6,841,000||$9,678,000||$10,920,000|
|Average Pay Per Patient||NA||$52.00||$64.50|
What are the quality measures?
Quality metrics set by CMS every year can change and the 2021 metrics are:
|Controlling A1C Levels||Fall Screening|
|Flu Immunization||Tobacco Use Screening|
|Screening for Depression and Follow-up Plan||Colorectal Cancer Screening|
|Cancer Screening||Controlling High Blood Pressure|
|Depression Remission at 12 Months||Statin Therapy for Cardiovascular Disease|
How does CHQCA help with MIPS?
The network receives an aggregate score based on the performance of the entire ACO. CHQCA reports quality measures on your behalf and submits them to CMS for MIPS adjustment.
MIPS Score of CHQCA:
|Quality Score||50/50 points||50/50 points|
|Professional Fee Schedule Appointment||+1.68%||+1.39|
What are the expectations once involved in the ACO?
CHQCA is made up of highly motivated, committed, and exceptional clinicians who want to align with like-minded clinical partners that share their dedication to the triple aim. Throughout the year, the ACO hosts meetings that network partners are expected to attend at least 75 percent. Our goal is to set reward practices to provide high-quality and cost-effective care to our patients.
In addition, we strive to collaborate, communicate, and commit to the triple aim of healthcare to offer a better patient experience, high-quality outcomes and provide cost-effective care.