An Inside Look at Shifting to a Culture of Accountable Care & Transparency

Onpoint is excited to announce that Elizabeth H. Johnson, MD, MS, the CEO of the MMC Physician-Hospital Organization (MMC PHO), has agreed to serve as Chair of our Board of Directors. Dr. Johnson, who has more than 15 years involvement in healthcare leadership and more than 18 years practicing internal medicine, brings strong strategic vision and management in support of value-based, integrated, and patient-centered care to Maine’s ever-changing healthcare landscape. She is currently facilitating the MMC PHO’s shift to a culture of accountable care and transparency through participation in the Medicare Shared Savings Program (MSSP) offered by the U.S. Centers for Medicare & Medicaid Services (CMS). As CEO of the MMC PHO, wife of Dr. Daniel Soroff, and mother of two sons, Sam and Jake, Dr. Johnson feels a personal commitment to making Maine’s communities a better place to live, including improving how patients receive and experience their healthcare services.

Dr. Johnson, who joined Onpoint’s board last year, recently sat down with Chad MacLeod, Client Services Associate, to discuss her role with the MMC PHO, insights into the key components of a successful accountable care strategy, and her new responsibility as Onpoint’s Board Chair. Highlights from their conversation follow.

How does the MMC Physician-Hospital Organization fit into the larger accountable care strategy of its parent organization, MaineHealth?

The MMC PHO is a nonprofit organization with more than 1,400 physician members from the Community Physicians of Maine, who partner with MaineHealth member hospitals—from its northernmost member, Franklin Memorial Hospital (Farmington, Maine), to its southernmost, Southern Maine Health Care (Biddeford, Maine)— to deliver high quality, cost-effective healthcare to the communities that they serve. By participating in CMS’s MSSP, the MMC PHO is transitioning its health services delivery model to an accountable care structure, becoming MaineHealth’s designated Accountable Care Organization (ACO)—the largest ACO model in the state of Maine, and one of the largest in the country —with a focus on Southern Maine and select New Hampshire communities.

By becoming an ACO and collaborating with similar models in the state and across the country, Dr. Johnson notes that the MMC PHO is joining the effort to shift “the widespread volume-based payment system to one that is instead driven by the value of care that patients receive.” As Dr. Johnson comments, making this transition a reality will require staying true to the Institute for Healthcare Improvement’s Triple Aim dimensions: (1) improving the patient’s experience of care, (2) improving the health of populations, and (3) reducing the per-capita cost of healthcare. To meet these goals, the MMC PHO has devised a four-point strategy for its ACO: (1) Transition its primary care practices to a patient-centered medical home model, (2) ensure efficient distribution of system wide care coordination resources, (3) aggregate near-real-time claims and select electronic medical record information to improve information available to clinicians at the point of care, and (4) reduce unwarranted variation in care by enhancing transparency and support services.

By taking responsibility for the quality of care that the MMC PHO’s ACO provides its patients, specifically by “formulating value-based provider contracts that will be designed in partnership with MaineHealth,” Dr. Johnson says the organization’s ACO model will be able to realize shared savings and improve healthcare for the communities it serves.

How has the concept of accountable care evolved over the past few years, and what role will it continue to play in the future?

For the MMC PHO, the concept of accountable care has evolved considerably since the inception of the Affordable Care Act (ACA) of 2010. After entering into agreement with CMS to participate in its MSSP, the MMC PHO became MaineHealth’s designated ACO as a way to extend its value-based, MSSP contract model to the organization’s entire network of providers and the commercial payers with which it partners.

In a broader context, Dr. Johnson suggests that, “once the state of Maine, and the country as a whole, identifies a solution to effectively adopt a risk-based payment system — one founded on a patient-centered, value-based, and triple aim-focused design — we will begin to drive transformative change even faster.” Dr. Johnson adds that, since the MMC PHO has the critical combination of resources required to make this shift — experienced staff, technology, and data — the organization is in a unique position to lead the way in generating these new kinds of payment models.

What are the key data and analytic resources that you will rely on most as you continue to drive ACO strategies in the state of Maine?

According to Dr. Johnson, data management and analytics are foundational keys to the success of the MMC PHO’s ACO model. “It is impossible to drive a significant amount of change unless these models derive accurate, reliable, and timely data — the kind of data that health systems and providers can collectively trust,” she says. “Our mission — namely, to support the member physicians and hospitals in the delivery of value-based, integrated healthcare that is patient centered — depends on building a partnership with both payers and providers in order to marry both claims and clinical data into reports that are meaningful to people and excite them to drive change.”

Dr. Johnson points to financial information as the primary historical source of data that health systems and providers have relied on to drive transformation across communities’ healthcare settings. However, as times change, so does the understanding of the types of data most informative in evaluating effective accountable care strategies. Since the ACA’s inception, and the subsequent development of initiatives related to ACOs, “there’s been much needed discussion around identifying a basic set of metrics for quality and patient experience outcomes. That’s because, in order to truly improve in healthcare, you have to first understand those two incredibly important components,” Dr. Johnson notes. “Look at specialty care, for example. That’s a whole new frontier for us to explore in terms of generating quality and patient experience metrics. And it’s a fun and lively discussion because we are right at the tip of the iceberg in terms of understanding how to measure these types of outcomes that, before now, haven’t really been used to drive improvement in care delivery.”

As Onpoint’s new Board Chair, what role would you like the organization to play in the health data and analytics market?

“We can’t move to value —and produce value — without accurate, reliable, and timely data. In my role with Onpoint, I see the need to continue to promote and enhance the data management and analytic skills that we can provide to healthcare organizations as they continue to figure out what it means to deliver ‘accountable care.’ As we refine that very definition, data will surely be a driver of the discussion and informed change. And Onpoint, I believe, is perfectly poised to help deliver the data and analytics that we can use to support and advance accountable care strategies.”