MaineHealth ACO Board Approves Updated Conditions of Participation for Practices and Providers

July 13, 2018

The MaineHealth ACO board recently approved updated “conditions of participation” that define required activities for participation in the ACO during the remainder of 2018 and through 2019. These three fundamental conditions continue the ACO’s longstanding practice of regularly defining participation criteria that help drive engagement in value-based care and accountability.

The 2018 – 2019 conditions were developed through a collaborative process that included ACO leaders, the physicians who sit on the Physician Engagement and Accountability Committee (PEAC) and members of the Board of Directors.

The updated conditions of participations are:

  1. Complete annual compliance training.
  2. Demonstrate active use of 2015 Certified Electronic Health Record Technology (CEHRT) by December 31, 2019.
  3. Ensure that all providers attend one of the ACO’s educational forums on ambulatory documentation improvement and submit an action plan to recapture diagnosis condition coding gaps identified by the ACO.

“The conditions reflect a renewed sense of urgency around achieving and reporting measurable improvements in quality and utilization. As we enter into a downside-risk agreement with the Medicare Shared Savings Program in January, the stakes immediately become higher. We’ve had a few years to ease into value-based agreements. Now, we really have to commit,” says Jennifer Moore, the ACO’s chief operating officer.

Increasingly, a commitment to value-based agreements means a commitment to reporting accurate clinical data electronically. Medicare has set the standard for electronic reporting, requiring clinicians participating in the Merit-based Incentive Payment System (MIPS) to use 2015 Certified Electronic Health Record Technology (CEHRT). The ACO’s updated conditions of participation mirror this development, requiring that participants actively use 2015 CEHRT by December 31, 2019.

“For several years, we’ve been urging MaineHealth ACO participants to consider and eventually adopt use of an electronic health record,” says Jennifer Moore. “This year, responding to the increased importance of exchange of clinical data in value-based agreements, we’ve transitioned to a definitive date for EHR adoption.”

The conditions also address the accuracy of clinical data, reflected in a set of educational requirements in support of clinical documentation improvement in the ambulatory setting. Clinical documentation improvement is a current priority of the ACO, recommended by the Value Oversight Committee and endorsed by the Board of Directors. In a value-based care model, high-quality documentation leads to risk scores that more accurately reflect the true health of patient panels. Improved documentation can also unlock patient benefits that payers base on disease severity and can lead to improved communication between members of a patient’s care team.

Interested in learning more about the ACO’s updated conditions of participation? Providers and staff from ACO practices are invited to join a webinar and online discussion of these conditions and the updated financial distribution model on Thursday, September 20th. Registration is available here.

If you have any questions, please don’t hesitate to contact Sandi Daigle, MaineHealth ACO provider network manager, by email or call 207-482-7067.