Results
Quality Results
In 2022, MHACO maintained 17 value-based contracts that required reporting on more than 100 unique quality measures. To track performance on a month-to-month basis, the ACO selected 11 of these measures as overall markers of quality. We report monthly progress toward achieving these measures’ annual targets in what is known as the MaineHealth ACO Quality Heat Map. Download the final Heat Map for 2022.
Annual Wellness Visit Completion Rate, April 2020 – Dec 2022
Rates increased from 42.4% in April 2020 to 66% in January 2023.
Average Colorectal Cancer Screening Rate, Jan 2015 – Dec 2022
Rates increased from 58.3% in January 2015 to 73.2% in January 2023.
There was an issue displaying the chart. Please edit the chart in the admin area for more details.Percentage of Patients w/ HbA1c over 9%
Rates decreased from 19.6% in January 2015 to 15.8% in January 2023.
Percentage of Patients with Hypertension Controlled, Jan 2015 – Dec 2022
Rates increased from 64.7% in January 2015 to 69.3% in January 2023.
Commentary
Quality performance in 2022 reflected continued suppression of visits and utilization due to COVID, resulting in generally lower national benchmarks for quality measures such as breast cancer screening and colorectal cancer screening. MHACO’s colorectal cancer screening rates were more than six percentage points above the HEDIS 90th percentile national benchmarks in this measure. Medicare Annual Wellness Visits trended upward. Outcome measures such as blood pressure control and HbA1c control did not return to pre-COVID rates of performance in 2021, highlighting the ongoing challenges of primary care access.
Health Care Utilization Results
MHACO tracks three measures of health care utilization among its contracts’ beneficiaries each quarter, based on claims data.
- Avoidable emergency department (ED) visits
- Admissions
- 30-day readmissions
The graph below illustrates the 5-year trend, expressed in rates per 1000 beneficiaries.
Utilization Rates
Utilization Findings
2022 saw a decrease in avoidable ED use from 156/1000 at the end of Q4 2021 to 142/1000 at the end of Q4 2022. Admissions dropped during the same period from 89/1000 to 86/1000 and readmissions dropped from 92/1000 to 84/1000.
The 5-year trend sees avoidable ED use moving modestly lower, with the exception of a precipitous pandemic-related drop from Q2 2020 through Q1 2021. Admissions have steadily declined from a high of 122/1000 in Q1 2018 to 86/1000. Readmissions have remained over 90/1000 during most of the 5-year period, only falling below that rate in Q2 of 2022. The year ended with a readmissions rate of 84/1000.
Over the next two or more years, MHACO’s primary utilization focus will be the reduction of unwarranted care variation with a particular emphasis on end-of-life care and transitions of care. Improving transitional care management is associated with reducing readmissions. MHACO’s efforts in these areas will be aligned with the MaineHealth Balanced Scorecard and the Care Variation Reduction Workgroup.
Financial Results
Value-based care contracts that settled in 2022 reflect performance in 2021. Total annual earning displayed below includes shared savings plus pay-for-performance payments made to MHACO and directly to MHACO participants.
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Commentary
Of the $24,248,481 in value-based care revenue realized in 2022, $17,889,489 was distributed to MHACO participants in early 2023, including MaineHealth hospitals, MaineHealth Medical Group, St. Mary’s Health System and private practices. The remainder was retained by the ACO to cover a portion of operating costs and fund participant projects in 2023 that will contribute to increased value of care.
MHACO generates savings when participants meet targets for measures of quality, limit over-utilization and keep cost of care within reasonable limits based on acuity of patients’ conditions and certain demographic factors. They earn pay-for-performance incentives for closing gaps in care and submitting certain types of documentation.
Key drivers of favorable contract performance included high rates of screening for breast and colorectal cancers, improved rates of controlled diabetes and more precise and accurate clinical documentation. Unfavorably impacting our contract performance was a rebound in utilization during 2021, reflected most starkly by a 23 percent increase in ED visits over 2020. This rebound was not unexpected, however, since COVID caused a massive and unprecedented decrease in utilization in 2020.
