Focus on Population Health CDI
Generates ACO Shared Savings
By James P. Fee, MD, CCS, CCDS; Sonia Trepina, MPA; Jennifer Boles, CPC, CRC; and Joel Sparks, PMP
COST CONTAINMENT. IT’S a concept that accountable care
organizations (ACOs) cite frequently as they strive for shared
savings. This makes sense because expenditures drive cost
thresholds. If an ACO meets all quality benchmarks—and the
cost of caring for its attributed population is below that threshold in accordance with its minimum savings rate (MSR)—then
the ACO shares a defined percentage of the savings. Taking
steps to address cost outliers, reduce hospital admissions and
readmissions through preventive care, and prevent system
leakage for attributed patients should therefore theoretically
put the ACO on a path for financial success. So why do the majority of ACOs fail to realize shared savings payments?
To answer this question, an ACO must examine whether its
Timing is Important
costs make sense given the severity of its attributed patient
population. When costs remain high despite robust reduction
strategies, perhaps costs aren’t the problem. The real problem
could be the way in which providers document the patient
story. Costs typically correlate with chronic disease burden
and disease interactions. Does physician documentation por-
tray this risk? Oftentimes not. This is where population health
clinical documentation improvement (CDI) can help.
Unfortunately, many ACOs make the mistake of focusing exclusively on cost containment when their strategy should instead be twofold: Reduce costs and improve documentation,
thereby increasing the accuracy of expected population risk.
It’s easy to get derailed with costs because they’re a tangible
target for improvement. Another reason ACOs forget about
documentation is that they’re focused on all of the steps necessary to form the legal entity itself—forming a legal structure
to receive and distribute shared savings payments, considering tax status, raising capital for staffing and IT systems, and
more. It’s a huge undertaking, and inevitably something will
be overlooked. In most cases, that “something” is the documentation—even though it’s the single most important element that helps payers understand the complexity and morbidity of the population the ACO serves.
Best practice is to involve CDI from the beginning, and
ideally before an ACO is formed. This is because an ACO’s