North Central Arizona Accountable Care (NCAAC) is wholly owned by Dignity Health – Yavapai Regional Medical Center (YRMC) in Prescott, Az. The 45 participants include employed providers from YRMC and Summit Healthcare in Show Low as well as independent providers in the Prescott, Show Low and Sedona areas. NCAAC started in the MSSP in 2015, initially partnering with Northern Arizona Healthcare and other independent practices in Flagstaff and the Verde Valley. When that organization formed their own ACO, NCAAC brought on Summit Healthcare and the Show Low regional Clinically Integrated Network as the second largest participant after the YRMC Physician Care Group. NCAAC’s first year in the MSSP was 2015 as a Track 1, and moved into a Track 1+ two-sided risk model in 2018. In 2019 NCAAC received $2,663,475 in shared savings from CMS. NCAAC has been able to collaborate with primary care and specialty practices in the region, identifying and improving processes around quality and care management.

Based in Bakersfield, California, the Dignity Health Managed Services Organization (DHMSO) is an integrated management services organization (MSO) supporting 650,000 lives, of which 200,000 are Medicaid. The DHMSO specializes in delivering services needed for value based care administration and management, including third-party administration (TPA), utilization management, care management, call center for provider and member services, as well as IT and analytics.

The DHMSO provides supporting infrastructure in California as CommonSpirit Health develops and expands its Medicaid population health programs.

Growth Highlight

The DHMSO expanded in 2019 to manage a large, rural independent practice association (IPA) with a primarily Medicaid population, increasing access to care and targeted programs in communities in California’s central valley.

Operationally, the organization exceeds California’s regulatory requirement for high-performing claims operation status with 98% timeliness and 96% accuracy. The DHMSO is built to scale to process 1 million claims per day, and could be expanded to a multi-state model with high-touch
services provided locally.

The CHI St. Alexius Health regional health care system was formed in April 2016, when Catholic Health Initiative purchased Bismarck St. Alexius hospital and clinics to form the largest health care system in central and western North Dakota.

The system is comprised of a tertiary hospital in Bismarck, and critical access hospitals (CAHs) located within North Dakota and Minnesota at Baudette, Breckenridge, Carrington, Dickinson, Devils Lake, Garrison, Lisbon, Little Falls, Oakes, Park Rapids, Turtle Lake, Valley City, and Williston with numerous clinic locations and outpatient services.

CHI St. Alexius Health – Bismarck also manages five CAHs in North Dakota which are located in the communities of Ashley, Elgin, Linton and Wishek, as well as Mobridge Regional Hospital & Clinics in Mobridge, SD.

Quality Highlight

With its division office located in Fargo, geography presents a huge challenge for the North Dakota market. To ensure the success of a value-based strategy across their market, they’re working to promote effective communication and collaboration.

To date, their efforts have yielded results, including:

• A 17% increase (to 93%) in childhood immunizations for ages 0 to 3.
• Mammography rates climbed from in the 40th percentile to above the 90th percentile.
• Well-child visits for children over age 3 rose above the 90th percentile.
• State honor roll recognition for one of their sites for wellness visits and immunizations, including adult immunizations.
• Utilizing virtual visit platforms to enhance care for patients.
• Building a network of health coaches assisting in providing care across the continuum.

Central Valley Quality Care Network (CVQCN) launched on 7/1/2020.

CVQCN has joined the other California clinically integrated networks and Dignity Health Medical Foundation physicians from California to form the Dignity Health Care Network (DHCN). This new entity will be participating in the CMS Medicare Shared Savings Program as a Basic Track, “Level A” Accountable Care Organization (ACO).

The network participates in Blue Shield PPO ACO (effective 7/1/20) and in January 2021 will also be participating in commercial ACO PPO contracts with United Healthcare and Anthem.

Serving regions across California, Dignity Health Care Network (DHCN) is one of the largest Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACO) in the country. DHCN was formed to increase collaboration across the California markets and better coordinate our population health strategy. DHCN launched in mid-2019 and applied to be in MSSP beginning in 2020.

By forming a single large ACO, we are better able to build upon our data analytics capacity, share learnings across the markets, and create more alignment between the Dignity Health Medical Foundation and the clinically integrated networks.

Santa Cruz Quality Care Network (SCQCN) is the newest network in California, with the CIN’s board of managers currently working to build the organization. SCQCN has 90 providers and counting from across Santa Cruz County who’ve been working together to manage capitated lives as Physicians Medical Group of Santa Cruz for 25 years and now as Dignity Health Medical Network-Santa Cruz. Payor agreements are in place with United Health and Anthem, with a Blue Shield contract in process.

SCQCN is working to build community relationships and educate CIN participants about the contracts they are involved in, with the goal of aligning the activities of the medical network and the CIN as closely as possible to focus on the same quality measures and initiatives.

One of the newest networks in California, San Joaquin Quality Care Network (SJQCN) has 388 providers and manages more than 3,000 lives. As a newer network, SJQCN has been focusing on building community relationships and educating CIN participants about the contracts they are involved in.

To further educate SJQCN providers on the network and the contracts, as well as their performance data, the network plans to hold regular town hall meetings with groups to discuss new contracts (including benchmarks and quality metrics), review data, and discuss areas of improvement.

The Greater Sacramento Division Value-Based Operations Structure oversees all value-based agreements in the division and consists of a partnership among six Dignity Health hospitals, Mercy Medical Group and Woodland Clinic Medical Group (foundation model) as well as Hills Physicians Medical Group (IPA).

The VBO structure fosters collaboration, accountability and stakeholder engagement with all VBA partners, with the goal of improving utilization and quality performance for all value-based members based on an integrated delivery continuum of care model.

Quality Highlight

Greater Sacramento’s physician groups are consistently recognized for their work. In 2019, Hill Physicians Medical Group and Mercy Medical Group won IHA Excellence in Healthcare Awards. Both practices, along with Woodland Clinic Medical Group, were recognized with Elite Status in America’s Physician Groups 2019 Standards of Excellence. Hills Physicians Medical Group was also honored with an IHA Exemplary Performance Award for Patient Experience Domain (Solano Region). And Mercy Medical Group was recognized as a Right Care Initiative Top Performer for diabetes control and lipid management, and by the American Heart Association for target blood pressure.

The ComonSpirit Health Texas Division is supported by a diverse and aligned collection of primary care and specialist practitioners. One of our physician platforms is CHI Texas Health Network, our CIN/ACO. The CIN is pivotal to the future success of the CHI Texas Division by increasing market share and offering alternatives to patients and insurers participating in the value-based market. The network serves patients across nearly 22,000 square miles of southeast Texas.

The Baylor College of Medicine and the Baylor St. Luke’s Medical Group are members of the CIN. Between the CIN (insured) and ACO (Medicare) populations, the organization has approximately 89,000 covered lives in value-based arrangements, with the goal of increasing to 200,000 by 2022.

The ACO has achieved a MIPS Score of 103% across the Texas Division, resulting in an FFS increase of 1.68% with Medicare and has also achieved a score of 100% in quality metrics for our own Employee Health Plan in CY 2018, which was the highest in the CHI system. The network is projecting $7 million in MSSP shared savings for 2019.

Strategy Highlight

With an emphasis on population health, Texas Health Network seeks to compete not only on price, but also on access and service.

Through care management/coordination and discharge planning as well as the integration of EMR and population health data, we will create a continuum of care that emphasizes quality. These efforts will make navigating the health care system easier for patients, helping to attract patients to our network.

CHI Saint Joseph Health Partners (SJHP) was established in 2012 as a physician-led clinically integrated network. As the most advanced clinically integrated network in the state, SJHP is uniquely positioned to make a real difference, in the health of the people of Kentucky, by working along-side-of independent and employed providers.

SJHP is leading the way in value-based care, which measures, reports and rewards excellence in health care delivery. Through our multidisciplinary care management approach, we are able to recognize long-term solutions to disease management by understanding and managing the spectrum of healthcare needs including social determinants of health.

By analyzing health data, we are able to stratify risk and focus on those who incur the highest amount of medical cost and address those members who are at risk for developing more serious health complication. Utilizing our skilled and diverse care management team, our solutions, designed for a person-centered approach, encourage a 1:1 relationship between care coordinators and the individual. This holistic model integrates an individual’s health, medication management, nutrition, exercise and stress reduction which may affect the ability to improve and sustain better health.

Quality Highlight

With a focus on preventive screenings, cardiovascular diseases and diabetes, as well as patient adherence to the care plan and physician compliance with best practices, SJHP was recognized by America’s Physician Groups as a 5-Star “Exemplary” ACO for two consecutive years. SJHP has achieved over $33 million in savings in Medicare programs and $7 million in savings managing the commercial employee health plan. Participating in a three-year Medicare Bundle Payment Care Improvement (BPCI) program, SJHP reduced readmission rates by 50%, achieving $4 million in savings with increased patient satisfaction and quality scores.
In 2019, SJHP worked with six CHI hospitals to provide transition-of-care services for patients who are at high risk for readmissions to ensure continuity of care and reduction of readmissions. SJHP has been able to reduce acute care readmissions substantially since beginning this initiative.