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Mercy Health Network ACO - MercyOne III

Medicare Shared Savings Program: ACO III | ACO IV

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Doctors, hospitals, and health care providers establish ACOs to work together to provide higher-quality coordinated care to their patients, while helping to slow the growth of health care costs.

Mercy Health Network ACO is one of 477 ACOs participating in the Shared Savings Program, as of January 1, 2021. Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs have the opportunity to receive a portion of the Medicare savings generated from lowering the growth in health care costs as long as they also meet standards for high quality care.

Since ACOs first began participating in the Shared Savings Program in early 2012, thousands of health care providers have signed on to participate in the program, working together to provide better care to Medicare beneficiaries.

 

Medicare Contact Information

For general questions or additional information about Accountable Care Organizations (ACOs) or the Medicare Shared Savings Program (MSSP), please visit www.medicare.gov/acos.html or call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

 

Integrity & Compliance Hotline

Mercy Health Network ACO utilizes an anonymous reporting hotline for employees or contractors of the ACO, ACO participants, and ACO providers/suppliers, and other individuals or entities performing functions or services related to ACO activities to report suspected problems related to the ACO to the designated ACO Compliance Official. Any individual who, in good faith, reports suspected wrongdoing can make reports anonymously and always without fear of retaliation.

Mercy Health Network ACO encourages reporting of privacy and security incidents; policy and procedural complaints; suspected illegal activity including fraud, waste and abuse; retaliation for reporting such issues; and any other legal or ethical concerns. The two options for reporting include:


Population Health and Risk Management System. This is a data registry to track billing and clinical information of the ACO’s patient population. The data registry allows the ACO to identify patients with care opportunities and to monitor the quality performance of ACO participants and eligible Outside Parties. The ACO and the data registry Vendor provide support to integrate data from ACO participants’ and eligible Outside Parties’ systems to the data registry, in addition to user access to the system.

This includes the development of computer interfaces and dashboard interfaces for ACO participants and eligible Outside Parties. This arrangement provides transparency and promotes accountability for the quality and overall care of ACO-assigned Medicare beneficiaries, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on July 12th, 2017.

 

Care Coordination Module. This application is used to standardize, document, and track care interventions. This system allows the ACO to coordinate the care of the ACO’s patient population by connecting ACO participants and eligible Outside Parties on one care coordination platform. The ACO and the application Vendor provide user access of the Care Coordination Platform to ACO participants and eligible Outside Parties. 

This arrangement allows for greater care coordination of ACO-assigned Medicare beneficiaries between ACO participants and eligible Outside Parties, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on July 12th, 2017.

 

Health Coaches. RN Health Coaches proactively intervene with the ACO’s patient population to assist in behavioral change to meet health and life goals. Health Coaches allow the ACO to deliver the ACO Health Coach program at the ACO participant and eligible Outside Party-level. The ACO provides Health Coach services in primary care and acute care settings to ACO participants and eligible Outside Parties.  

This arrangement allows for greater care coordination, including post-discharge follow-up and preventative care services, of ACO-assigned Medicare beneficiaries, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on July 12th, 2017.

 

Health Coach Training. This is a training program designed to optimize the health and well-being of the ACO’s patient population. This training allows the ACO to educate RN Health Coaches on foundations of patient-centric care and techniques for behavioral change for improved care delivery at the ACO participant and eligible Outside Party-level. The ACO provides training for all new Health Coaches and on-going training for all established Health Coaches that work at the ACO participant and eligible Outside Party-level. 

This arrangement leads to improved quality and overall care of ACO-assigned Medicare beneficiaries, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on July 10, 2019.

 

Mercy Provider Portal. This Integration Platform is used for clinically-integrated network (CIN) collaboration and secure distribution of datasets as it relates to the ACO’s patient population. This platform allows the ACO to collaborate with ACO participants and eligible Outside Parties on operational, financial and clinical improvement activities by integrating multiple applications on one, secure platform.

The ACO provides user access of the Mercy Provider Portal to ACO participants and eligible Outside Parties. This arrangement allows for greater coordination and standardization of care delivery for ACO-assigned Medicare beneficiaries, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on July 12th, 2017.

 

Clinical Documentation Improvement (CDI) Program. This Program was created for the purposes of ensuring complete and compliant clinical documentation, coding and billing practices across the ACO. The ACO and Program Consultant provide support, including audit functions, training and education to ACO participants and eligible Outside Parties to facilitate improvement in clinical documentation.

This arrangement will lead to more accurate risk scoring and identification of the ACO’s patients, including ACO-assigned Medicare beneficiaries that can benefit from care interventions, which will assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on March 27, 2017.

 

Community Health Workers. Community Health Workers proactively intervene with the ACO’s patient population to assist in addressing gaps in health-related social needs. Community Health Workers allow the ACO to deliver the Community Coordination program at the ACO participant and eligible Outside Party-level. Community Health Worker services will be provided in primary care settings to ACO participants and eligible Outside Parties.

This arrangement allows for greater care coordination at the community level of ACO-assigned Medicare beneficiaries, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on December 13, 2017.

 

PatientPing. This software service allows the ACO to share (i.e. send and receive) information with ACO participants and eligible Outside Parties that are involved in the care of the ACO’s patient population, including ACO-assigned Medicare beneficiaries. This service enhances the ACO’s Quality Assurance and Improvement Program to ensure coordinated care across the continuum, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on April 10, 2019.

 

Ride Sharing Program. This transportation services solution from Uber Health, Des Moines Area Regional Transit Authority (DART), and DART Paratransit leverages an existing network of drivers to transport patients to and from medical appointments and to pick up prescription medications. This solution closes a significant social determinants of health need for the ACO’s patient population, including ACO-assigned Medicare beneficiaries, who are identified as eligible for this service through a universal social determinants of health screening and other demographic factors. This Program, in coordination with ACO participants and eligible Outside Parties, assists the ACO in furthering its Quality Assurance and Improvement Program to ensure patients are receiving basic healthcare needs, and will result in improved quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on April 10, 2019.

 

Grants Exploration. The ACO dedicates staff to researching, facilitating, and writing grants on and behalf of ACO participants and eligible Outside Parties for opportunities that assist in healthcare delivery redesign. These resources allow the ACO to expand its Quality Assurance and Improvement Program through funding and model piloting, to improve care delivery for the ACO’s patient population, including ACO-assigned Medicare beneficiaries. These resources assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the ACO BOM on April 10, 2019.

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