One of many 2025 Excellence Award winners introduced on the latest Nationwide Affiliation of ACOs (NAACOS) fall assembly was Nebraska Well being Community (NHN), the ACO co-founded by two well being techniques in Nebraska: Methodist Well being System and Nebraska Medication. Following the convention, Healthcare Innovation spoke with the Omaha-based group’s CEO, Lee Handke, PharmD, M.B.A., and vp of value-based care, Mallory Callahan, M.P.A.S., PA-C.
Shaped in 2010, Nebraska Well being Community has greater than 3,600 major care and specialty physicians and superior observe suppliers working all through the Omaha metropolitan space, Fremont and western Iowa.
Earlier than becoming a member of NHN, Handke was the senior vp, well being community companies for Blue Cross and Blue Protect of Nebraska.
Healthcare Innovation: Is it pretty uncommon to have two well being techniques coming collectively to kind and oversee an ACO?
Handke: I’d say it’s uncommon. The opposite one which some individuals find out about is Delaware Valley ACO. I believe it makes plenty of sense, as a result of in a city like Omaha, there’s a lot partnership. There’s a lot sharing of referral patterns with specialties. Plenty of suppliers had been skilled on the med middle or at Creighton. For us, it has been a pleasant mix of getting the robust help of the well being techniques, nevertheless it additionally permits us to do a few of that peer-to-peer comparability, and nobody desires to be second to their friends. So once we share knowledge, it’s a good manner for us to actually encourage high quality.
Callahan: I believe we’re distinctive. Anytime we speak to different ACOs, which is fairly continuously, we get the identical query. There are many alternatives in the best way that we steer our two giant ships attempting to get to the identical location. There are clearly totally different paths that we every take to get there, nevertheless it positively results in distinctive conversations, and I believe plenty of alternative for us to do issues in a different way. I see that inside every of our strategic initiatives we’re positively dealing with issues in a different way, with one being on the tutorial facet [Nebraska Medicine], and one being extra of that neighborhood focus [Methodist Health System].
HCI: The NAACOS award presentation famous that Nebraska Well being Community participates in 14 value-based care agreements throughout Medicare, Medicare Benefit, Medicaid, and industrial plans. I used to be watching a panel session at NAACOS the place leaders spoke in regards to the challenges of managing a big portfolio of value-based fashions throughout a number of sorts of payers. What would you say is essentially the most difficult factor about it? What sorts of infrastructure has your group constructed as much as handle that portfolio?
Handke: There are plenty of challenges there. One includes how we deal with the quite a few high quality measures, throughout these 14 agreements. Now we have a centralized, built-in knowledge warehouse the place we herald each claims and medical knowledge, so it doesn’t matter what the payer is measuring or telling us of their reporting or displaying of their portals, we will see for ourselves the place now we have alternatives, and which may be a top quality alternative or could also be a value alternative.
We strive to verify the contract phrases are honest, affordable, they usually’re issues that we expect we will obtain. One instance of that’s just lately, we noticed some very disturbing traits in Medicare Benefit, so we went again to the payers and mentioned we’re not going to tackle danger in these agreements at this level.
Callahan: Internally, now we have a staff of inhabitants well being coordinators who’re the specialists in several contracts. Now we have that break up out by sort of payer, after which all of these traces of enterprise. So, for instance, now we have a United Healthcare knowledgeable, and now we have a Nebraska Medicaid knowledgeable, so that they know the nuances of that contract language extraordinarily nicely. Additionally they are monitoring how our high quality efficiency appears to be like. All year long, they’re monitoring if we might redo this for subsequent yr. What are the important thing contracting items that we’d wish to see change? We additionally do plenty of forecasting and modeling, earlier efficiency and attempting to map out trajectories. I do really feel like we have gotten plenty of sophistication in that within the final two or three years.
From a top quality perspective, as Lee mentioned, we do have at the least 60 distinctive high quality measures. I at all times joke that it might be superb if Blue Cross industrial and United industrial might agree on high quality, however they don’t.
We have created a chart of all of these simply to indicate the magnitude of the variety of high quality measures and what every one is really measuring. From that, we have developed what we name the Nebraska Well being Community core high quality measure set. It is a subset of measures. Now we have 11, and we’re what’s the frequency in our totally different contracts, what’s the medical relevancy, in order that we will see outcomes we wish to search for from beginning to grave — immunizations, annual wellness visits, in order that we’re actually encompassing all totally different teams. Within the knowledge aggregator system, no matter contract, for these core high quality measures we’re ready to have a look at the ACO stage, the TIN stage, clinic stage, right down to the NPI, and generate hole lists in order that if a gaggle says breast most cancers screening is not one thing they care about, we will nonetheless ensure we’re getting these people in for breast most cancers screenings.
HCI: I heard that one in every of your hospitals teams is on Epic, and the opposite is on Oracle Cerner, and smaller clinics are on a large number of different EHRs. How a lot of a complicating issue is that? Has working with a knowledge aggregator accomplice solved plenty of these points?
Callahan: Now we have a whole staff targeted proper now on our MCQ [managed care quality] reporting and getting all of that data into our knowledge aggregator system. What we began was Epic and Cerner having weekly feeds for these core high quality measures, however then we have been capable of increase to another measures which have a big sufficient denominator that we will get to the payer.
After I first began, we simply had claims coming to us and really minimal EMR knowledge. It is continuously evolving. Proper now we’re targeted on getting extra of that knowledge in for our bigger neighborhood clinics, after which subsequent yr, beginning to concentrate on our bigger specialty clinics. Now we have a full-time mission supervisor who’s these totally different knowledge items. I’d like to say that that’s historical past, however we’re positively nonetheless studying.
We’re working by means of MCQs now and there are eCQMs [electronic clinical quality measures] sooner or later.
HCI: What about different cost fashions focused at particular specialties, like within the kidney care house, oncology or cardiology? Do you take part in any of these?
Handke: We had one in every of our well being techniques, Methodist, take part within the optionally available bundles a number of years in the past. I believe they thought the work they put into it was not price what they received out of it. They backed out of that.
Mallory and I are each excited to see the specialty applications come ahead, as a result of one of many flaws with value-based agreements up to now is they have been so major care-focused that our specialists actually really feel like they have been on the sidelines. The truth is, we’ll have our doctor dinner assembly, and the specialists say, ‘Hey, I am solely going to come back so many extra occasions the place I’ve to listen to about childhood immunizations and wellness visits.’ We’re excited that CMS goes in that path. Although these applications are going to be necessary, I believe so long as it is a honest taking part in subject and we will work with our specialists to know what we being measured by, and what alternatives now we have, then we actually welcome these applications that can interact the specialists.
HCI: However did you and your specialists take a look at earlier ones such because the Oncology Care Mannequin or Kidney Care Decisions?
Handke: We did not on the time. I believe we had been simply so targeted on the fundamental value-based agreements. Most likely, if these had been launched right this moment, we could have had a unique perspective on it. We nonetheless have alternative within the major care house to have a look at extra of our risk-adjusted utilization measures, however we do have specialists who’ve been reaching out and have an interest and asking what’s popping out of CMS.
As soon as we see a few of these new applications come out in 2026, we’ll have the ability to begin wanting on the knowledge and the place we’d have our biggest alternative.
HCI: The NAACOS write-up about your group famous that you’ve labored on embedding neighborhood well being staff into medical websites. What sorts of issues do they concentrate on, and does it contain screening sufferers for health-related social wants?
Callahan: That’s been a multi-year mission. A colleague and I labored with the College of Nebraska Medical Heart on a HRSA grant on recruiting, coaching and putting neighborhood well being staff throughout the state. We had been attempting to have a look at how we might successfully display screen for social determinants of well being, and the place would possibly place these people in order that we’re maximizing that chance to indicate not solely the ROI, however might we then maintain and scale this up?
We checked out our knowledge. One factor that we observed was that there have been sure pockets the place ED charges had been by means of the roof or inpatient conversion was excessive, however the danger was actually low, so we thought this may be place to place in a person who might try this screening.
We labored with our well being techniques. We designed what that job description would seem like, got here up with funding alternatives from payer companions, and needed to position them strategically to indicate that return on funding.
Now we have a number of neighborhood well being staff who work within the emergency division, they usually do screenings on sufferers there. We began with the ED, and these neighborhood well being staff at the moment are going out and in of the inpatient house as nicely, following these sufferers on their inpatient journey to attempt to shorten their size of keep in the event that they’re medically secure. They’re additionally going out into the neighborhood house. They’re serving to them in the event that they want to enroll in Medicaid or they’re having meals instability or housing points.
What we discovered from our knowledge is that sufferers who’ve these social drivers of well being price 4 occasions greater than these people who do not, they usually’re using the ED six occasions extra. So we really feel that the ROI is fairly vital.
One problem to navigate is how can we not solely display screen sufferers however pull these social determinant of well being codes into the claims? As a result of they don’t seem to be risk-adjusted within the present state, and a few of these claims are truncated earlier than then. So it is getting them to truly pull by means of onto our claims to indicate that full story. We have been doing mapping inside every of our EMRs to have these questionnaires pull by means of to a Z code routinely.
HCI: The NAACOS award additionally mentioned that you’ve established partnerships throughout the continuum, together with with expert nursing services (SNFs) and hospice and residential well being. Have you ever constructed a post-acute community and labored on them with high quality?
Callahan: Now we have a post-acute care community that’s comprised of expert nursing services. Then in 2024 we introduced in dwelling well being and hospice. We used a data-driven strategy to determine who had been those we had the best referral foundation with from our hospitals and developed standards for them to be a part of a most popular community.
We’re actually attempting to be sure that on the time of discharge and on the time that referral is acquired that there is higher perception into what that care transition appears to be like like. We have developed scorecards that we share with that council on a quarterly foundation that present what’s their star ranking, and what number of sufferers they’re accepting, what’s their size of keep, and what’s their danger rating.
We’re now beginning on the identical journey with dwelling well being to meet up with the place our SNFs are, and beginning to have a look at a few of these key efficiency indicators. We shared our first scorecard final week, so I believe there’s nonetheless alternative for us to determine different key efficiency indicators, nevertheless it has already spurred nice conversations.
HCI: Did you’ve gotten any total impressions of this yr’s fall NAACOS assembly by way of traits?
Handke: Everybody’s speaking about reporting MCQMs and eCQMs, and how you can navigate that. We’re additionally whether or not we must always take into account having multiple MSSP ACO based mostly on membership. Ought to there be a sophisticated one and a starter one? We talked to some individuals on the convention who’ve accomplished some work round that. I attended a fantastic presentation on approaches to expert nursing. So regardless that Mallory talked about how now we have these networks in place, we understand we nonetheless have plenty of work to do there.
Additionally, everybody’s ready to see what’s subsequent from CMS. Sadly, with the federal government shutdown, we did not hear straight from CMS. However lots of people are getting ready for what these specialty applications — for low again ache and coronary artery illness — will seem like after they come out in 2027. The periods are nice, however I just like the networking that comes with the convention as nicely, and simply listening to what different persons are pondering.
