In the Members in Action series, the American Hospital Association highlights how hospitals and health systems are implementing new value-based strategies to improve healthcare affordability. This includes work to redesign the delivery system, manage risk and new payment models, improve quality and outcomes, and implement operational solutions.
The Illinois Rural Community Care Organization (IRCCO) was approved in 2015 as a Medicare Shared Savings Accountable Care Organization (ACO) Track 1. IRCCO was one of 41 ACO Investment Models (AIM) funded by the Center for Medicare and Medicaid Innovation in 2016. The AIM program seeks to encourage coordinated, accountable care in rural areas by offering pre-payment of shared savings in both upfront and ongoing per-beneficiary, per-month payments.
As of January 2018, IRCCO comprised 24 critical access and rural hospitals and their associated physician practices and clinics in rural communities across Illinois. The value of the ACO is that physicians, advanced practice practitioners, hospitals and other clinicians come together to provide high-quality coordinated care to patients, while helping to slow healthcare cost growth. The focus is providing primary care and keeping the patient close to home. Patient Centered Medical Homes and patient-centric care are the heart of the process and provide the framework for change in the primary care setting. IRCCO is one of 561 ACOs participating in the Medicare Shared Savings Program (MSSP). Beneficiaries seeing healthcare providers in ACOs have the freedom to choose doctors inside or outside of the ACO.
For 2018, IRCCO has approximately 25,000 attributred Medicare beneficiaries and is managed by the Illinois Critical Access Hospital Network (ICAHN). The goal of the IRCCO is to learn how to function as a shared savings ACO and to learn how to manage risk as healthcare moves to the value-based model.
Each participating IRCCO member is required to financially support the operating cost of the ACO before and after the AIM funding ends in December. ACOs require trained clinical and data specialists to understand data trends and to help hospital staffs and their medical providers better manage the care of their patients. ACO participants can be a physician or hospital and can share in the portion of earned shared savings based on their volume as well as their financial and quality performance. Accurate coding and managing beneficiary costs are essential for laying the groupdwork for financial performance. ACOs utilize an IT platform and care coordination modules to track cost and beneficiary utilization, as well as quality performance.