MissionPoint beyond Medicare

Quasi-ACO programs involving insurers continue to thrive

MissionPoint Health Partners’ partnership with BlueCross BlueShield of Tennessee is just one piece of the organization’s commercial puzzle. While the official “accountable care organization” title often refers only to groups engaged in the Medicare Shared Savings Program, approaches developed for Medicare patients can be applied elsewhere. So MissionPoint, like many other ACOs, is engaging with commercial clients and moving their model beyond the federal program.

“At our core, we are employed to reduce health care spend for a client,” said Allison Foulds, MissionPoint’s vice president of client services. “That client could be the federal government, a managed care organization, an employer or a payer. Whoever is paying the bill, whoever is responsible for the risk, is usually who is employing us.”

For BlueCross, the partnership provides an additional network of physicians in the insurer’s service offering. Patients that receive care from MissionPoint providers also receive the organization’s oversight, assistance in coordinating care between providers and in handling other problems wherever they may arise.

“Our partnership is not about building an ACO,” said Clay Phillips, VP of network innovation for BlueCross. “It is about building a product around collaborative care delivery and improved care integration. Instead of trying to deploy a one-size-fits-all ACO strategy, we are attempting to meet our strategic partners where their capabilities and services are today.”

A patient admitted to a facility in MissionPoint’s network receives an introductory visit from a company health partner while still in the hospital. Within 36 hours of discharge, MissionPoint’s clinical transition team follows up with the patient to ask questions about status, medications and recovery.

“If there are problems identified, the health partner will contact the physician’s officer, and the physician will decide how to proceed,” Foulds said. “We wrap around their care. We support the care that the patient is receiving from the clinician.”

MissionPoint offers another set of eyes on the care process and seeks to improve results by focusing on holes in the system. By assisting patients in making follow-up appointments or arranging transportation, the organization is addressing problems that, left unacknowledged, could lead to readmissions and higher costs.

The MissionPoint model was built to support a variety of patient populations. Though the quality metrics and contractual obligations may differ between clients, the care platform and infrastructure translate among the various insurer tracks.

In the self-insured world, quality metrics are approached through provider engagement. Provider quality is reviewed and a major objective is achieving physician buy-in to the concept of accountability. Though some coordinated care organizations require physician groups to pay into the program, MissionPoint requires engagement. If providers are asked, they sit on committees that work through the clinical elements of cost.

For example, MissionPoint’s prescription committee looked at pediatric asthma data and found that a high percentage of patients having their inhaler prescription filled were not getting a secondary application piece of the inhaler because it wasn’t covered under their benefit plans.

“The group of physicians knew the efficacy of the inhaler dropped without the extended applicator, so they brought that information to the employer who added it to their coverage,” Foulds said. “Then we saw the ER admission claims of pediatric asthma attacks go down significantly.”

One major lesson MissionPoint has learned in its first two years is recognizing the true scope of what health care accountability means.

“When you’re talking about chronic diseases and the costs associated with them, you’re looking at a total package of lifestyle components,” said project analyst Alex Norton. “Considering all of those components was a paradigm shift [...] We can’t have clinical blinders on.”

Norton said recognizing the social elements that exacerbate the severity of cases like diabetes and hypertension was eye-opening and forced the company to look beyond quality metrics and into the variety of lifestyle issues that influence health and wellness.

“With our Medicare patients, we see different spikes in costs for men and women at different times,” she said. “You see the spike in costs for women, which can be related to the death of spouse, and you have all these almost anthropological questions that are fascinating even though they exist beyond the clinical understanding of wellness. We have to connect those dots.”

MissionPoint continues to try many solutions to multi-faceted problems. Next on the agenda is applying the model to Medicaid and uninsured populations, which pose a completely different set of challenges and opportunities. But there will be no clear, broadly applied solutions. For MissionPoint, success comes in many small, innovative steps.