Submitter Name: Jami Berger, RN
Organization: Arizona Care Network, LLC

ACO Start Date: 2/1/2012 

Operational Problem Faced: About Arizona Care Network (ACN): ACN is a physician-led accountable care organization that represents a partnership between Dignity Health Arizona and Tenet-owned Abrazo Community Health Network. Consequently, ACN is the only ACO in the country co-owned by two competitors in the same marketplace. The network’s 6,000 participating providers include system and independent providers, with more than 300,000 value-based lives. ACN has distinguished itself as a high performing network, exceeding $40 million in total medical cost savings across value-based contracts spanning Medicare, Medicaid, commercial and direct to employer arrangements. The challenges facing our healthcare system have been thoroughly documented and discussed. Even so, US healthcare spend is still on the rise, quickly approaching 20 percent of GDP; doctors are still laboring under an administrative burden that is largely blamed for high burnout rates; and patients still endure a customer experience that isn’t tolerated in any other industry.In addition to these challenges, we ask our providers to trade guaranteed fee-for-service revenue for an uncertain gain share payday that takes months to materialize. We ask them take on new population health activities while they still endure the pain of a dated third-party administration and payment model that is plagued by inefficient processes, data system silos and duplication of efforts. In what other industry do professionals provide a service with no confirmation of the amount or timing of their payment? We wanted to find a way to improve the revenue cycle by reimbursing providers more quickly and reducing the number of unpaid claims due to verification issues discovered long after care has been delivered. Doctors spending so much time on administrative work are not spending quality time communicating with and touching their patients. And the administrative burden is a leading cause of burnout. When we asked our providers what they need from their ACO to succeed in value-based medicine, they told us:

• Clear metrics, so we know what we need to do to be successful
• Data transparency, so we always know how we are performing against the standard
• Timely insights, so we can close care gaps to improve the health of our patients
• Accurate payment of the incentives and gain share
• But don’t increase our administrative burden

Our challenge was to reduce the significant administrative burden on providers and improve the healthcare experience for patients. Concurrently, we would have to convince a skeptical network of doctors that a new technology was worth their attention.The current industry focus on patient experience, customer satisfaction and increasing efficiency in healthcare as a way to reduce costs have all opened doors to the application of innovative Blockchain technology. 

Innovative Solution: Innovation #1: ACN's Provider Rewards Program (PRP) has always been a popular benefit of participation. ACN's joint owners created a significant fund to enable ACN to reward primary care providers for the hard work associated with value-based medicine. Each year’s incentive program aligns with the clinical metrics and network activities that drive our success on value-based contracts. As such, the PRP is a leading indicator for gain share. The incentive is paid quarterly, and while the doctors appreciated the check they wanted more timely data to drive improvements and maximize their incentive. Innovation #2: Our solution is the ACN Care. Wallet, a mobile digital wallet that delivers anytime access to metrics that matter, timely self-assessment, transparent, actionable data, and convenient notification, all right at hand on the doctor’s smart phone via Blockchain technology to directly reduce administrative costs and friction associated with value-based care delivery and payments.And our first step was to link it to the Provider Rewards Program.The ACN Care Wallet was designed specifically for physicians, so their input in its creation and involvement in refining the tool was an essential strategy to ensure they will use it. As they used the prototype and suggested improvements, we were able to respond with changes to meet their needs. This involvement helped drive adoption, which is important for several reasons: Frst, the ACN Care.Wallet displays actionable insights that allow providers to proactively deliver better care. Within the Care.Wallet they can view their count of members that have clinical care gaps and other key metrics. Data may drive population health, but care is delivered one patient at a time. If a provider sees on their ACN Care.Wallet performance card that 200 of their 1,000 Medicare patients have not had their annual wellness visit, they can proactively reach out to them to schedule the appointment. As they close care gaps, blockchain updates the information and credits the provider’s performance towards the Provider Rewards Program. They have complete transparency into how all metrics are calculated, current status and a trendline of expected incentive. This prospective view of performance delivered exactly what providers were looking for. And on October 15th, we distributed the first ever digital currency of Care.Coins direct to the wallet holder as their incentive payment. They can hold or redeem at any time for US dollars. Second, the Care Wallet for Physician is just the beginning. ACN is already in production on a Care.Wallet for use by patients. For it to be successful, the providers and practices need to use the tool first. So, driving provider adoption was an essential first step. Then when we dropped their financial rewards into the Care Wallet with instant access to redemption, adoption soared. Innovation #3: The Care.Wallet for patients, already in production, will automatically and continuously synchronize benefits information, including deductibles, co-pays, co-insurance and out-of-pocket expenses. Patients can use a Care.Card application as a digital ID for immediate authorizations, to schedule appointments with physicians and share accurate benefits information. 

Results: ACN first introduced the Care.Wallet to our Board -- highly engaged providers, many of them PCPs and participants in our Provider Rewards Program. In all honesty, very few started out believing that “just another app” would be the solution to their frustrations. At each stage of testing we addressed their questions and objections and helped them serve as beta testers using placeholder data. By “playing” with the app, they could see how it would deliver the prospective information they needed to provide better care to their patients who need it most and simultaneously maximize their financial incentives. A soft launch with live data gave providers a view into their own performance data and that of their practice, plus comparison to the network average. Just five weeks after launch, the app was in use by 75 percent of eligible practices; by end of year, usage exceeded 80 percent. More than 62 percent of Care.Coins earned have been redeemed. Blockchain is one of the hottest topics in healthcare today because of its promise to improve transparency, drive clinical quality, relieve administrative burdens and reduce costly waste. With a 360-degree view of a patient’s care, the entire care team can communicate, coordinate and eliminate unnecessary processes and procedures that drive up healthcare costs.ACN intends to be the most technology-enabled ACO in the country. We focus on technologies that add value for providers and patients alike, so clinicians can spend more time doing what they have been called to do – care for patients.