Louisiana Physician Exec Describes Keys to MSSP ACO’s Success
Darrin Menard, M.D., medical director of the Louisiana Medicare Shared Savings Program (MSSP) Enhanced ACO, recently described how his accountable care organization has evolved to become more successful in the program.
Menard, a practicing family medicine physician in Scott, Louisiana, was speaking at a Primary Care Collaborative event focused on their new report, “Primary Care: the MVP of MSSP.”
The report – written in partnership with the AAFP Robert Graham Center and Simple Healthcare – found that ACOs with more than 50 percent of physicians engaged in primary care consistently outperformed those with less than a majority of primary care physicians.
The research also found that primary care-centric ACOs were more likely to lower costs and earn back savings through MSSP, generating 2.4 times as many savings other ACOs over a six-year period.
Menard, whose ACO is featured in a case study in the report, works in partnership with Aledade to expand value-based care across Louisiana. In 2020 his practice received the Million Hearts recognition for their efforts on hypertension. The ACO has 15,000 beneficiaries and 29 practices and clinic participants, according to the PCC report.
In 2022, the Louisiana ACO had a 15% savings rate and a quality score of 91 out of 100 while serving a very vulnerable population on the social deprivation index.
He said one key to the ACO is teamwork. “All of our practices have a representative at our board meeting every month, and they not only attend the board meetings, but they participate heavily to start creating the kind of care that we want for our patients,” he said.
“That is a big factor in getting to the to the point of savings and becoming innovative in how we think about caring for our patients and things that we can do to increase savings. Having said that about our board members, it trickles down to our staff in our offices.”
Menard added that he has developed a lot of trust with every other practicing physician in the ACO, because he is still practicing medicine. “I see patients three days a week, full time on those days, and do my ACO work on those other two days. And just being in battle together with all the other docs across the state makes a difference.”
The Primary Care Collaborative case study about the Louisiana MSSP ACO notes that Aledade’s app is the backbone for sharing practice-specific data insights. “It is EHR agnostic, allowing practices to access data insights without additional configuration,” the report states. “The app provides hospital or ER notifications, patient summaries and care gaps to individual practices. It also serves as a platform for daily huddles; these data allow for specific and targeted interventions so patients get the right care at the right time. The app prioritizes actionable items and work lists for patients with and without appointments.”
Menard noted that being able to have the data coming to practicing physicians, and then being able to see that data in comparison to other practicing groups in the organization has made everyone very competitive to get better and better every year.
“We started off the ACO journey in 2015 with a couple of years where we didn't make savings, and then our third year, we finally achieved the savings, primarily because everyone started getting anxious about the fact that we were not making savings,” Menard said.
“We came up with an initiative in the last quarter of that year, where we started looking at our ED cases.” They realized that just calling the patients after they went to the ED was not enough. “We really wanted to make an extra effort at keeping those patients out of the emergency room. We made a goal — if every provider could prevent one ER admission per week for the rest of the year, that we would get the savings. And they accomplished the goal, and that really started the trend of thinking how do we decrease cost of care more and more year in and year out? And to be honest, we just continue to do the same work over and over again.”
As we enter holiday season, Menard said one of the ACOs’ goals is trying to keep patients home for the holidays. They touch base with them on a regular basis, especially patients who need it the most, the sickest patients in they population. Using data analytics from the ACO, they reach out to the sickest patient populations and touch base with them on a regular basis. “The patients understand they have a home, that they can they can count on us to be there for them in their most important needs,” he added. “But it's more than that. This preventative care space that we've been working towards these last seven or eight years has really allowed the patients to know that they can call us first for anything that they need, and that really helps them to stay out of the hospital. With the ACO we keep expanding into the population of every primary care provider, talking to their patients in the same way, getting the time to spend with them in this value-based care setting, and getting paid for it. These Medicare ACOs are really beneficial for us to be able to do that.”
Other parts of the PCC meeting were devoted to policy issues around increasing the emphasis on primary care. Anthony Wright, executive director of Families USA, said the report is promising in that it highlights models where the focus on primary care and prevention are working well. “How do we continue to evolve the financing because right now that is not actually the natural way that our system is organized, added Wright, who served for many years as executive director of Health Access California, where he led state efforts to win patient protections, fight budget cuts, invest in the safety net, expand coverage, and advance equity. “The financing structures are not quite there, and we need to do more to incentivize an investment in primary care, which has been underinvested in, and do more to make sure that the work that advanced primary care models do is actually paid for and invested in, so that we get can actually yield the savings on the back end.”
