Illinois Rural Community Care Organization
- Need: To improve value-based care and organize the efforts of rural Illinois' independent providers with a shared vision of population health management.
- 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 as rural providers they had to do something to embrace population health management strategies, such as using an accountable care organization (ACO) model. To prepare, ICAHN conducted a feasibility study to determine potential beneficiary numbers for an accountable care organization (ACO).
A Centers for Medicare and Medicaid Services (CMS) initiative, the ACO Investment Model (AIM), had an eligibility requirement of preliminary prospective beneficiary assignment of 10,000 or fewer beneficiaries, with some exceptions for ACOs that starting 2015 or 2016 start-ups. The initiative also included exceptions for rural areas. AIM sought 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.
In response to these new care strategies and initiatives, ICAHN established their ACO, Illinois Rural Community Care Organization (IRCCO) as a limited liability company (LLC) under ICAHN. In 2016, IRCCO was an AIM innovation initiative recipient.
The newly-formed ACO is a collaborative effort of rural hospitals, clinics, physicians and other providers who recognized healthcare and social services is best integrated at the local level. Comprised of more than 230 medical providers, IRCCO serves a rural population of 350,000, and 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 to the CMS's AIM program, IRCCO is participating in the Blue Cross Blue Shield of Illinois (BCBSIL) Intensive Medical Home (IMH) program, an enhanced model of primary care focusing on the high-risk chronic care beneficiaries. This program is designed for ACOs and their currently insured BCBSIL beneficiaries. Through the BCBSIL program, IRCCO serves more than 1,000 high risk insurance beneficiaries.
As the managing organization for the ACO, ICAHN provides a nurse care manager for acute and chronic case management and provides outreach to the BCBSIL beneficiaries. This program does provide some revenue for the rural providers to engage in population health of the non-Medicare beneficiaries.
IRCCO focused on providing the framework and infrastructure vital to developing local systems of care. The newly formed ACO uses its AIM funding to further enhanced IT infrastructures, such as integrated electronic medical record/claims-based reporting systems. These new systems will also assist with quality management of at-risk patient populations.
IRCCO was a case example chosen by the American Hospital Association as an example to highlight innovative models of care delivery.
Unique services developed by IRCCO include:
- Registered nurses in the role of BCBSIL intensive medical homes (IMH) care manager
- Utilization of population health management framework for care navigation and patient-centered medical home models
- Part-time Chief Medical Officer as a program bridge to other participating physicians and medical providers
- Group software purchases to organize claims information, allowing providers and hospitals comparison data to other ACO participants
Current IRCCO initiatives:
- Developing an emergency department (ED) utilization program to reduce admissions
- Providing education and infrastructure for establishing the success of a chronic care management program
- Preparing for BCBSIL ACO engagement with overall birth-to-elderly quality metrics of the two ACO programs allowing for sustainability of population health interventions
- Expanding on the original BCBSIL IMH care management nurse to provide needed care coordination to hospitals with self-funded insurance programs, assisting participating hospitals with employee healthcare costs.
- IRCCO’s 2016 AIM quality measures and outcomes data revealed programs were at or above all measures of the ACO’s Consumer Assessment of Healthcare Providers and Systems (CAHPS ®), receiving only a few minor lower scores in remaining quality metrics.
- IRCCO-provided software assisted the participating ACO facilities in identifying areas of needed improvement, a process which further lends to the individual facility's ability to contribute to the overall ACO benchmarks.
- Quality measurements included staff education metrics in the areas of quality data, further providing each facility with the ability to identify gaps in care and allow implementation of new strategies.
- The Chief Medical Officer has helped providers build best practices, establish network guidelines, reducing variability and improving care.
- Regular meetings of regional care managers and member hospitals leading to increased communication that impacts program implementation for population health initiatives.
- ACO startup unknowns, especially organizational weak points in regards to quality measures. For IRCCO, this information came roughly a year into the ACO initiative engagement after the first CMS quality analyses were released.
- Providing analytic knowledge of claims data and quality metric results.
- Role identification: IRCCO leaders were initially unsure of tasks and duties, staffing needs for managing the various aspects of the ACO. This resolved with a final decision to outsource responsibilities to ICAHN.
- IT infrastructure and connectivity difficulties for linking all participants.
- Know what collaboration energy exists in core groups, whether it’s an ACO model or care strategy initiatives.
- Before committing to an organizational model, have some ideas about how participating providers would alter their services.
- If an ACO seems right, examine the ACO's core participants' dedication to longevity.
- Embark with trusted participants that will collaborate in order to achieve a shared vision of success.
Angie Charlet, Director of Quality & Educational Services, Chief Compliance Officer
Illinois Critical Access Hospital Network
Accountable Care Organizations
May 20, 2016
August 8, 2017
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.