Illinois Rural Community Care Organization
- Need: To improve value-based care and collaboration efforts of independent providers in rural Illinois.
- Intervention: A Medicare Shared Savings Program Accountable Care Organization (MSSP ACO) was established that participates in federal and state repayment programs.
- Results: The newly formed ACO is one of the first statewide ACOs to establish local care coordination programs that encompass hospital, clinic and practice settings.
In light of healthcare reform, Illinois Critical Access Hospital Network (ICAHN) members knew they had to do something as rural providers to keep up with the shift and prepare for population health management. ICAHN conducted a feasibility study to determine enough lives for an ACO. According to Centers for Medicare and Medicaid Services, ACO Investment Model (AIM) eligibility requires ACOs have a preliminary prospective beneficiary assignment of 10,000 or fewer beneficiaries. However, exceptions are made for ACOs that started in 2015 or will start in 2016 and are determined to be from a rural area.
In response, ICAHN established the Illinois Rural Community Care Organization (IRCCO) as a limited liability company (LLC) under ICAHN. In 2016, IRCCO was a recipient of the AIM through CMS. AIM seeks to encourage an increase of coordinated, accountable care in rural geographies by offering pre-payment of shared savings in both upfront and ongoing per beneficiary per month payments. Care coordination activities primarily focus on the management and prevention of chronic disease.
The newly-formed ACO is a collaborative effort of rural hospitals, clinics, physicians and other providers who recognized healthcare and social services are best integrated at the local level. IRCCO is comprised of more than 230 medical providers serving a rural population of 350,000. Through its Medicare Shared Savings Program, IRCCO serves more than 20,000 Medicare beneficiaries.
Rural medical providers associated with IRCCO include:
- 22 Critical Access Hospitals
- 1 rural community hospital
- 14 independent physician practices
- 35 Rural Health Clinics
In addition, IRCCO is participating in the Blue Cross Blue Shield of Illinois (BCBSIL) Intensive Medical Home (IMH) program, which is an enhanced model of primary care focusing on the high-risk chronic care beneficiaries. Through the BCBSIL program, IRCCO serves more than 1,000 high risk insurance beneficiaries. This program is designed for ACOs, and beneficiaries are currently insured by BCBSIL. As the managing organization for the ACO, ICAHN provides a nurse care manager for acute and chronic case management and outreach to the BCBSIL recipients enrolled in the program. This program provides some revenue for the rural providers to engage in population health of the non-Medicare beneficiaries.
IRCCO wanted to provide the framework and infrastructure vital to developing local systems of care. The newly formed ACO will use its AIM funding to build further enhanced IT infrastructures such as integrated EMR/claims-based reporting systems. These new systems will help with quality management of at-risk patient populations.
Some notable services that IRCCO had developed include:
- Provided a nurse as the BCBSIL IMH care manager
- Established framework for population health management through education and resources for care navigation and patient-centered medical home models
- Engaged a part-time Chief Medical Officer to bridge physicians and medical providers
- Group purchased software that helps organize claims data. Providers and hospitals can now compare themselves with other participants in the ACO.
Currently, IRCCO is in the process of:
- Developing an emergency department (ED) utilization program to reduce ED admissions
- Providing education and infrastructure for establishing the success of the a chronic care management program
- IRCCO just finished its AIM year one quality measures and outcomes. National AIM rankings will be available in June 2016.
- Software utilization helps ACO participating facilities know where they can individually improve in order to ensure success for the overall ACO. In addition, a participant’s success in quality
- The Chief Medical Officer has helped providers take initiatives in building best practices and guidelines for the network. In addition, the CMO engaged with providers in reducing variability and establishing standards of care.
- There are many unknowns when starting an ACO. Organizations will not know their quality weak points until roughly a year into being an ACO, after quality analyses are completed by CMS.
- Staffing was an issue. IRCCO leaders were unsure who was going to manage what pieces of the ACO and how many people were necessary for management. This was resolved with the decision to outsource that responsibility to ICAHN.
- IT infrastructure and establishing connectivity between every participant was difficult
Know what collaboration is available to your group, whether it’s an ACO model or otherwise. Before committing to an organizational model, have some ideas about how participating providers would change the way their services are offered.
Furthermore, if an ACO seems right, look at the foundational participants of the ACO for their dedication to longevity. Embark with participants you trust and that share a view of success as a collaborative effort.
Angie Charlet, Director of Quality & Educational Services, Chief Compliance Officer
Illinois Critical Access Hospital Network
Accountable Care Organizations
May 20, 2016
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.