HEALTHCARE REFORM Accountable Care Organizations: ACOs 101 - PowerPoint PPT Presentation

HEALTHCARE REFORM Accountable Care Organizations: ACOs 101 NOVEMBER 2011 The enclosed slides are intended to provide you with a general overview of accountable care organizations (ACOs), created within the healthcare reform Medicare Shared Savings Program (MSSP). This tool is designed to help distributors and manufacturers understand the basics of ACOs. For example, healthcare providers will be able to share in any savings they achieve if they meet certain quality performance measures. Realigning payment incentives, such as these, may shift the way providers deliver care and make purchasing decisions. This is one of many healthcare reform resources HIDA has developed. For more information on healthcare reform, visit www.HIDA.org/Reform, or contact HIDA Government Affairs at (703) 549-4432. DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM

begin April 1 and July 1 Savings Program (MSSP) include that providers must • Quality measures no longer agreement a three-year participation • Providers must commit to 2012; ACO agreements will • MSSP begins January 1, of ACOs by healthcare reform, which allows for be meaningful users of • The Medicare Shared • Share in any achieved Medicare cost savings, by reducing • Meet quality measurements • Coordinate patient care The Basics Accountable Care Organization (ACO) At-a-Glance A group of healthcare providers that agrees to work together to: is a provision of healthcare the voluntary creation the cost to deliver care through new efficiencies providers HOSPITAL SURGI-CENTER SKILLED NURSING FACILITY PATIENT A R E E C O M H EHR. DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM

• Hospitals that are partnering with or employ eligible physicians • Rural health clinics • Low-volume hospitals • Physicians in group practice arrangements • Networks of individual practitioners • Critical access hospitals • Nurse practitioners • Physician assistants • Specialists • Federally qualified health centers (FQHCs) The Goal: Coordinate Patient Care All Medicare providers may participate in an ACO, however ACO sponsors (or conveners) are limited to: Other providers, such as skilled nursing facilities, are eligible to participate, but do not have authority to convene ACOs at this time. DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM

• Medicare beneficiaries must be informed that their provider is participating in an ACO • Medicare beneficiaries have the right to decline care from an ACO • Proactive case management • Appropriately managed resources • Improved care transitions • Utilization of data on process and outcomes The Goal: Coordinate Patient Care Each ACO is prospectively assigned a minimum of 5,000 Medicare beneficiaries Patients are expected to benefit from being at the center of care through Coordinating Care + Measuring Quality = Improved Care DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM

measures • Care coordination and patient safety • In the second and third years, the share of savings will be tied to performance on quality domains • In the first year, providers must fully and accurately report on all four quality measure for each ACO, every year, to gauge financial performance • The Centers for Medicare and Medicaid Services (CMS) will develop a spending benchmark • Caring for at-risk populations • Preventive health • Patient experience The quality measures are organized into four domains, each with a common focus: • measures (see Appendix) The amount of savings an ACO may receive is linked to their performance on 33 quality • The Challenge: Efficient Care Quality improvement pays… Show me the money… DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM

Program on January 1, 2012. 9. Care Coordination/Patient Safety Congestive Heart Failure (AHRQ Prevention Ambulatory Sensitive Conditions Admissions: 10. Care Coordination/Patient Safety P P Claims NQF #275 AHRQ Prevention Quality Indicator (PQI) #5) Chronic Obstructive Pulmonary Disease (AHRQ Ambulatory Sensitive Conditions Admissions: P NQF #277 AHRQ Claims NQF #TBD CMS Risk-Standardized, All Condition Readmission* 8. Care Coordination/Patient Safety Survey NQF #6 AHRQ CAHPS: Health Status/Functional Status 7. Patient/Caregiver Experience P Survey NQF #5 AHRQ Quality Indicator (PQI) #8 ) Claims 6. Patient/Caregiver Experience NQF #97 * This measure has been under development and finalization of this measure is contingent upon the availability of measures specifications before the establishment of the Shared Savings P P GPRO Web Interface NQF #101 NCQA Falls: Screening for Fall Risk 13. Care Coordination/Patient Safety P P GPRO Web Interface AMA•PCPI/NCQA Discharge from an Inpatient Facility P Medication Reconciliation: Reconciliation After 12. Care Coordination/Patient Safety P P Program Reporting EHR Incentive CMS EHR Incentive Program Payment Percent of PCPs who Successfully Qualify for an 11. Care Coordination/Patient Safety P CAHPS: Shared Decision Making P P P Survey NQF #5 AHRQ CAHPS: Patients' Rating of Doctor 3. Patient/Caregiver Experience P P Survey CAHPS: How Well Your Doctors Communicate P 2. Patient/Caregiver Experience P P Survey NQF #5 AHRQ Information CAHPS: Getting Timely Care, Appointments, and 1. Patient/Caregiver Experience P NQF #5 AHRQ 4. Patient/Caregiver Experience P Survey NQF #5 AHRQ CAHPS: Health Promotion and Education 5. Patient/Caregiver Experience P Survey NQF #5 AHRQ CAHPS: Access to Specialists Appendix: Measures for Use in Establishing Quality Performance Standards that ACOs Must Meet for Shared Savings Pay for Performance Phase In NQF Measure Method of Data Domain Measure Title #/Measure R = Reporting P=Performance Submission Steward Year 1 Year 2 Year 2 AIM: Better Care for Individuals R R R R R R R R R R R R R R R R Source: Centers for Medicare & Medicaid Services. 42 CFR Part 425. October 20, 2011. DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM

CMS P GPRO Web Interface GPRO Web Interface Measurement Community NQF #0729 MN Hemoglobin A1c Control (<8 percent) Diabetes Composite (All or Nothing Scoring): 22. At Risk Population - Diabetes P P P GPRO Web Interface Pressure Measured within the preceding 2 years Proportion of Adults 18+ who had their Blood 21. Preventive Health P GPRO Web Interface NQF #31 NCQA Mammography Screening P 23. At Risk Population - Diabetes NQF #0729 MN Blood Pressure <140/90 Diabetes Composite (All or Nothing Scoring): 25. At Risk Population - Diabetes P P Community GPRO Web Interface Measurement Community NQF #0729 MN Diabetes Composite (All or Nothing Scoring): Diabetes Composite (All or Nothing Scoring): Low 24. At Risk Population - Diabetes P P Measurement GPRO Web Interface Measurement Community NQF #0729 MN Density Lipoprotein (<100) 20. Preventive Health P Tobacco Non Use NQF #43 NCQA P GPRO Web Interface NQF #421 CMS Adult Weight Screening and Follow-up 16. Preventive Health P P GPRO Web Interface Pneumococcal Vaccination Tobacco Use Assessment and Tobacco Cessation 15. Preventive Health P P GPRO Web Interface PCPI NQF #41 AMA- Influenza Immunization 14. Preventive Health 17. Preventive Health P Intervention NQF #418 CMS GPRO Web Interface NQF #34 NCQA Colorectal Cancer Screening 19. Preventive Health P P NQF #28 AMA- GPRO Web Interface Depression Screening PCPI 18. Preventive Health P GPRO Web Interface P Appendix: Measures for Use in Establishing Quality Performance Standards that ACOs Must Meet for Shared Savings Pay for Performance Phase In NQF Measure Method of Data Domain Measure Title #/ Measure R = Reporting P=Performance Submission Steward Year 1 Year 2 Year 2 AIM: Better Health for Populations R R R R R R R R R R R R R R R Source: Centers for Medicare & Medicaid Services. 42 CFR Part 425. October 20, 2011. DISTRIBUTION DISTRIBUTION STREAMLINING HEALTHCARE SM