23AMGA.ORG MARCH 2019
The key to success in value-based con- tracts is the timely
aggregation and analysis of
clinical and claims data and
providing actionable information
to clinicians at the point of care.
The South Bend Clinic (SBC) in South
Bend, Indiana, took this approach,
and it has paid off in spades: Our
130-doctor, provider-owned, multispecialty group accountable care organization
(ACO) has enjoyed financial success in
contracting with the MSSP, as well as with
several commercial, Medicare Advantage,
and Medicaid managed care plans.
While ACOs have been around for a decade, 1
only a minority of the 838 ACOs now in existence know how to succeed under value-based
contracts. 2 In 2017, for example, only 34% of the
472 ACOs in the Medicare Shared Savings Program
(MSSP) qualified for bonuses under the program. 3
Since most of these ACOs met the program’s quality
requirements, 4 this means that most were unable to save
Medicare enough money to receive a share of the savings.
Lack of Actionable Data
SBC’s achievement is the result of both hard work and
changes in how we use data. In our organization’s early
days, physicians received quality and cost reports based
on claims data that were often several months out of date.
warehouse is key
to clinic’s MSSP
By Andrea Cichra