Description

The Community Care Partnership of Maine Accountable Care Organization (CCPM ACO) began in August 2015 and became a Medicare Shared Savings Program ACO in January 2016. The ACO began when Penobscot Community Health Care (PCHC) and St. Joseph Healthcare in Bangor partnered together. This Federally Qualified Health Center (FQHC) and community hospital, respectively, then invited rural community health centers and community hospitals to join.

While collaborating with major healthcare facilities in Bangor and Portland, the rural facilities in this ACO still maintain independence. Each member organization is considered a joint owner in CCPM and receives one vote in decision-making, whatever the organization's size.

The three participating hospitals are:

• Cary Medical Center
• Millinocket Regional Hospital
• St. Joseph Healthcare

The 14 participating FQHCs are:

• Bucksport Regional Health Center
• Eastport Health Care, Inc.
• Fish River Rural Health
• Greater Portland Health
• Harrington Family Health Center
• Health Access Network
• Hometown Health Center
• Islands Community Medical Services, Inc.
• Katahdin Valley Health Center
• Nasson Health Care
• Penobscot Community Health Care
• Pines Health Services
• Sacopee Valley Health Center
• St. Croix Regional Family Health Center

Through one of its member organizations, CCPM was awarded a 2016-2019 Federal Office of Rural Health Policy (FORHP) Small Health Care Provider Quality Improvement grant. In 2021, CCPM secured more than $1 million in funding to support several of its initiatives, including comprehensive pre-visit planning, diabetes prevention, and early detection of lung cancer.

Services offered

CCPM uses a health information exchange (HIE) called HealthInfoNet to share patient information among the hospitals and FQHCs. This HIE allows the facilities to provide better-coordinated care to their patients and to collect population health data. In addition, the HIE provides real-time predictive analytics in order to predict (and work to prevent) readmissions. Through the RWJF grant resources, CCPM is working to incorporate social determinants data from two regional community action programs.

CCPM also allows member organizations to share services in order to reduce costs and duplicated services. Rural organizations do not have to "reinvent the wheel" when they can borrow another organization's expertise or services.

CCPM is a forum for sharing best practices on how to help patients be as healthy as possible and how to help reduce unnecessary emergency department visits or hospitalizations. Rural member organizations particularly like how monthly sharing with their peers reduces rural isolation and provides collegial support.

CCPM hosts a Complex Case Review Group. Biweekly meetings follow a case presentation format in which presenters outline a patient's background, demographics/social history, pertinent clinical history, and social determinants of health and then solicit recommendations from an interdisciplinary team of experts that includes pharmacy, psychiatry, care management, and social work. CCPM also offers a Pharmacy Consult service to prevent adverse drug events via medication reconciliation.

CCPM also created a Skilled Nursing Facility Collaborative to partner with skilled nursing facilities as well as a patient diagnostic code workgroup to educate billers, coders, and clinicians on the importance of accurately capturing diagnosis code information.

In 2019, CCPM launched Pharmacy Consults as a benefit of ACO membership. Any patient of its 17 member organizations is eligible to receive this service. CCPM employs a Clinical Pharmacist to support this service line. Upon referral, the Clinical Pharmacist performs a comprehensive medication review and issues recommendations that includes:

• Changes in the medication regime
• Instructions for monitoring for specific desired (or undesired) outcomes
• Suggestions for management of potentially inappropriate medication use

In 2019, CCPM began onboarding and training medical assistants (MAs) to support its member organizations with pre-visit planning. CCPM's centralized MAs are specially trained to provide comprehensive pre-visit planning, reducing administrative burden and freeing up time for both the provider and MA.

CCPM offers medication-assisted treatment (MAT) consultation on a contracted basis to interested member organizations. In addition, CCPM offers a free online Continuing Medical Education (CME) Series as a benefit of ACO membership. Any employee of the 17 member organizations is eligible to access the library of AMA-accredited CME modules, many of which are tailored to an FQHC audience.

Results

Over the course of several years, CCPM has implemented a complex LLC legal structure, compliance program, organization, and financial structure. CCPM also covers about 100,000 patients in Maine.

CCPM completed its fifth year of a shared savings contract with Medicare in December 2021. In addition, it has implemented shared savings arrangements/contracts with the health payers Anthem, Anthem Medicare Advantage, Aetna, Harvard Pilgrim, and Cigna. The ACO anticipates a similar arrangement with another Medicare Advantage Plan in the next few months.

In 2016, CCPM had a savings of $4.3 million in the Medicare Shared Savings Program (MSSP). In 2017, this savings was over $8.8 million. In 2018, CCPM generated over $17.2 million in savings under the MSSP, resulting in about $7.4 million shared savings for CCPM, which was then distributed back to its participating member organizations. This success continued in 2019 and 2020. CCPM is the only ACO in Maine, and one of a handful of ACOs nationwide, to have achieved shared savings for 5 consecutive years (2016-2020).

The ACO was named a 2016 Case Study in Innovation by the American Hospital Association and presented its work at the AHA Rural Health Care Leadership Conference in February 2017.

Challenges

While CCPM views its vast geography spread across the state as a strength, it recognizes that the distance poses some logistical barriers. To overcome these barriers, CCPM hosts the majority of its committee meetings virtually to reduce travel time for attendees, a practice that allowed it to continue operations during the ongoing COVID-19 pandemic.

CCPM also contends with the use of multiple electronic medical records (EMRs) across its 18 member organizations, which at times poses challenges in starting new initiatives.

Replication

Some member organizations had tried other ACO models but felt that they didn't "fit" into these work cultures. CCPM was a better fit because the member organizations shared similar values, like focusing on their communities' immediate needs.

CCPM also credits its long-standing success to the leanness of its organizational structure. All of CCPM's officers fulfill their role in a part-time capacity while also serving in a separate role at one of its member organizations.

Contact Information

Mary Prybylo, RN, MSN, FACHE, CEO
Community Care Partnership of Maine
207.907.1100