Annual Strategic Review Process for the Johns Hopkins Medicine Alliance for Patients (JMAP) Accountable Care Organization and Emerging Accountable Care Best Practices

From the 2018 HVPAA National Conference

Sarah Himmelrich (Office of Johns Hopkins Physicians and Johns Hopkins Medicine Alliance for Patients, LLC), Sarah Johnson Conway (Johns Hopkins School of Medicine and Johns Hopkins Medicine Alliance for Patients, LLC), Scott Feeser (Johns Hopkins Community Physicians and Johns Hopkins Medicine Alliance for Patients, LLC), Jennifer Bailey (Johns Hopkins Community Physicians and Armstrong Institute), Steve Kravet (Johns Hopkins Community Physicians), Linda Dunbar (Johns Hopkins Health Care), Cassandra Peterson (Johns Hopkins Health Care), Sarah Kachur (Johns Hopkins Health Care), Rab Razzak (Johns Hopkins School of Medicine), William Saway (Columbia Medical Practice), Dewayne Oberlander (Columbia Medical Practice), Steve Schwartz (Potomac Physician Associates), Lindsay Hebert (Johns Hopkins Health Care), Arielle Alvaro (Johns Hopkins Health Care), Scott Berkowitz (Johns Hopkins School of Medicine and Johns Hopkins Medicine Alliance for Patients, LLC)

Background

The Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Accountable Care Organizations (ACO) with approximately 3,000 primary and specialty care providers, both employed and independent, is responsible for 40,000 attributed Medicare beneficiaries. ACOs must be strategic about selecting initiatives in the quest for higher value.

Objectives

Review the JMAP annual strategic planning process aimed at improving the value of health care services.

Methods

JMAP conducts a collaborative strategic planning process that seeks to determine where new efforts are needed to drive value in the upcoming year. The broad theme for the 2017 retreat was provider and care team engagement and the opportunities identified for discussion were grouped into 4 categories: (1) engagement through the care model, (2) engagement strategies for specialty care providers, (3) provider engagement in end-of-life care initiatives, and (4) opportunities for alignment of the care model for the Medicare population. Approximately 70 clinical and administrative representatives gathered representing key partners including Johns Hopkins HealthCare, the JHM hospitals, the JMAP ambulatory practices, care coordination, quality, and analytics teams as well as Medicare beneficiaries. JMAP performance data were reviewed along with current ACO best practices and evidence-driven proposals were generated. The proposals were discussed, evaluated for merit, and then voted on by the multi-stakeholder group based on impact and effort

Results

The selected interventions included: further refinement of the approach to care coordination and integration of behavioral health services, specialty integration including Part B drug costs and imaging appropriateness, integrating palliative care into ambulatory specialty care, pursuing alignment of services and interventions for all Medicare beneficiaries, and further engagement of beneficiaries through focus groups. In 2016, the most recent performance year with annual results, JMAP achieved a 92.42 percent quality score and an overall slight reduction in cost of care ($0.5M below benchmark, 0.1 percent reduction). While we did not achieve shared savings, there were very positive trends in key utilization indicators compared to 2015 including: 3 percent reduction in hospitalizations, 5 percent reduction in readmissions, and 2 percent reduction in emergency department visits.

Conclusion

The annual strategic review has been an essential and iterative process based on performance data and evidence-based practice that fosters multi-stakeholder engagement and the best care for patients.

Implications for the Patient

As ACOs simultaneously seek to improve quality and decrease costs in risk-based contracting agreements, they will need an evidence-based tool kit of high-value services. The JMAP strategic planning process fosters improved engagement and application of evidence-based practice, through an objective assessment for the purpose of improving program performance

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