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Houston Methodist Coordinated Care ACO case study

Who they are

Houston Methodist Coordinated Care ACO is a Medicare ACO with over 52,000 traditional Medicare beneficiaries. It includes over 300 primary care physicians in the Houston area.

Goals and challenges

With ACOs required to report to CMS starting with the 2025 performance year, HMCC wanted to have its workflows and data-gathering strategy in place before reporting became mandatory. It needed a partner who could combine data from multiple EHR sources into 1 reporting account on HMCC quality performance for CMS. HMCC currently has over 1,600 providers with data spread across 13 different electronic health records (EHRs).

HMCC also wanted a partner who could provide provider education about their data and conduct quality reviews with ACO leadership. In 2022, it selected Healthmonix as its reporting solution.

Solutions

Healthmonix developed a phased strategy to ensure HMCC would be ready for mandatory reporting by 2025.

2022 performance year

Most of HMCC’s data resides in its Epic EHR. Healthmonix began uploading that Epic data in 2022, using multiple rounds of sample data and workgroup sessions to focus on data needs. These sessions helped refine the data output and allowed Healthmonix to begin layering in Epic Community Connect data.

2023 performance year

With the Epic data loaded, Healthmonix began devising a solution that would give HMCC’s individual private practices an optimal view of their data. It needed to integrate data from 30-plus non-Epic sources to accomplish this.

Healthmonix settled on creating individual staging accounts for 2023. These test accounts allowed practices to review their data, assess and address quality gaps, and ultimately approve it for the 1 main reporting account for CMS ACO quality metrics all payors all patients. The staging accounts served as a temporary solution for 2023, with HMCC and Healthmonix agreeing that all 2024 data would go directly into the main reporting account.

Practices appreciated this approach. It allowed each one to send initial data to Healthmonix and have it assessed by the Data Management team. When data formatting was agreed to, data was sent to the practices for quality review. This allowed the practices to work on any care gaps before their data went into the main account.

2024 performance year

With all of the needed data flowing from HMCC’s EHRs to Healthmonix, 2024 centered on refining data and phasing out the individual staging accounts. The collaborative work between HMCC and Healthmonix in 2022 and 2023 allowed data gap reviews to become more fruitful. HMCC also took advantage of Healthmonix’s MIPS Analytics software to better understand its data.

Results

Healthmonix’s phased data strategy and HMCC’s early preparation worked as a future readiness plan to successfully enable 2025 mandatory submission of quality data to CMS. Today, HMCC can see all patient data in a single account. This solution can segregate patient data in numerous ways, such as by branch, practice, or individual provider, to provide feedback and to improve performance.

HMCC wasn’t content to simply aggregate data for reporting purposes. It wanted to understand where it had gaps with quality care and workflows, which it did through weekly team working sessions with Healthmonix.

For example, one practice discovered its providers were rarely completing Measure 134: Depression Screening, which is the most challenging measure required for ACO reporting. Healthmonix worked with that practiceto develop a workflow that led to a surge in completed depression screenings to drive success for this practice and HMCC ACO.

Healthmonix and HMCC reported MIPS CQMs for 2023 and will report both MIPS CQMs and Medicare CQMs in 2024. HMCC scored well, 2 years ahead of the CMS requirement to report.

HMCC also benefitted from its numerous working sessions with Healthmonix. These sessions provided education on measure specifications, codes needed for reporting, and quality reviews. HMCC’s improved understanding of its data has been one of its biggest gains from its relationship with Healthmonix and something it has enjoyed the most.

Validation

“Healthmonix is a true partner in driving HMCC ACO’s continued success in CMS ACO quality performance with all payors. Our relationship and work achieved together with our providers is foundational for succeeding in the required 2025 CMS submission of quality data.”

Julia D. Andrieni, MD MACP
President & CEO, HMCC ACO
Houston Methodist