High-Risk Patient Roster Helps Atrius Pioneer ACO 'Beat the Benchmark'

High-Risk Patient Roster Helps Atrius Pioneer ACO 'Beat the Benchmark'

They don't call them pioneers for nothing.

A high-risk patient roster, a retooled geriatric care model and a preferred SNF network are just a few Atrius Health innovations on the healthcare frontier.

Atrius Health is one of 32 participants in the CMS Pioneer ACO program testing alternative payment and program design models for accountable care organizations. Emily Brower, Atrius Health executive director of accountable care programs, shared first-year lessons during a recent webinar, Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim.

In case you missed this webinar, you still have a chance to watch this highly-rated program.

Register to view the conference today or order your training DVD or CD:

Emily Brower

Atrius was drawn to the three-year Pioneer ACO program for a number of reasons. First, it offered the non-profit alliance of six independent medical groups a chance to showcase its core competencies, including its rich data environment, foundation in the patient-centered medical home (PCMH) model and new home care services, Ms. Brower said.

Also, it gave the Massachusetts organization a chance to build a population-based approach to managing its Medicare population as a whole, with Triple Aim goals as a foundation.

And finally, they had a lot of faith in the staff of the CMS Center for Medicare/Medicaid Innovation, where the project resides. "We feel they really understand the issues we face in being accountable for care across the continuum," noted Ms. Brower.

The Pioneer ACO shared savings and loss model challenges participants to perform against nationally identified trends. CMS take a participating ACO's population and creates from the national Medicare database a reference population, she explained. "Were trying to beat the trend in that national population, or 'beat the benchmark.'"

In 2012, Atrius launched six clinical and technical initiatives to address the program's 33 quality measures "the gate through which the ACO achieves savings." Key among them is its eight-step high-risk patient roster review, a hallmark of Atrius's redesigned geriatric care model.

You can "attend" this program right in your office and learn the features and preliminary indicators from Atrius' year-one focus on managing high-risk patients and high-cost events specifically the management of post acute care and development of preferred partnerships and developments and focus areas for year two of the program.

Its so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer any time of the day or night, whenever convenient for you and your colleagues and benefit from the archived recording of the conference, including the Q&A period.

You'll get to listen to the question and answer session to hear the investment required to launch the ACO and the expected payback model; the critical functional capabilities inherent in starting and running an ACO and which functions are likely to be outsourced; how Atrius is coordinating patient care and tracking individual patients and their outcomes; the risk stratification tool used for identifying patients and care gaps; how data is exchanged between the VNA, SNFs and the ACO; how to select and recruit the SNFs to participate in the preferred SNF network; and how to use CMS data to beat the trend.

To register for the on-demand re-broadcast, download an .MP3 file or order the training DVD or CD-ROM of Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim, please visit:

I hope you find it useful.


Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network