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ACO Performance

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HI-FIVE: Health Informatics For Innovation, Value & Enrichment (Clinical Perspective)

Columbia University

4.6 (125 Bewertungen) | 6.4K Teilnehmer angemeldet

HI-FIVE (Health Informatics For Innovation, Value & Enrichment) Training is a 12-hour online course designed by Columbia University in 2016, with sponsorship from the Office of the National Coordinator for Health Information Technology (ONC). The training is role-based and uses case scenarios. Also, it has additional, optional modules on other topics of interest or relevance. Although we suggest to complete the course within a month's timeframe, the course is self-paced and so you can start and finish the course at anytime during a month's time period. No additional hardware or software are required for this course. Our nation’s healthcare system is changing at a rapid pace. Transformative health care delivery programs depend heavily on health information technology to improve and coordinate care, maintain patient registries, support patient engagement, develop and sustain data infrastructure necessary for multi-payer value-based payment, and enable analytical capacities to inform decision making and streamline reporting. The accelerated pace of change from new and expanding technology will continue to be a challenge for preparing a skilled workforce so taking this training will help you to stay current in the dynamic landscape of health care. This course is one of three related courses in the HI-FIVE training program, which has topics on population health, care coordination and interoperability, value-based care, healthcare data analytics, and patient-centered care. Each of the three courses is designed from a different perspective based on various healthcare roles. This first course is from a clinical perspective, geared towards physicians, nurse practitioners, physician assistants, nurses, clinical executives and managers, medical assistants, and other clinical support roles. However, we encourage anyone working in healthcare, health IT, public health, and population health to participate in any of the three trainings. If you would like to obtain continuing medical education (CME) or continuing nursing education (CNE) credits, you will need to have eligible credentials, complete the entire course, and complete the evaluation survey at the end. The HI-FIVE team verifies after each month that these requirements have been met and then a separate certificate (fee may apply) is distributed to you from our accreditation office. Please allow time for processing. If you have any further questions about continuing education, please see our website at www.hi-fivetraining.org. Accreditation Statement The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA Credit Designation Statement The College of Physcians and Surgeons designates this enduring material for 12.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The planning committee members are: Rita Kukafka, DrPH, MA, FACMI; Bruce Forman, MD; Gil Kuperman, MD, PhD; Virginia Lorenzi, MS, CPHIMS, FHL7, and Victoria Tiase, MSN, BN. None of the members of the committee, who planned this CME Activity, have any relevant financial relationships to disclose. The release date is 2/1/17 and the expiration date is 1/31/18. This activity is eligible for 12 continuing nursing education (CNE) credits. Columbia University School of Nursing, Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

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Kompetenzen, die Sie erwerben

Health Informatics, Value-Based Pricing, Communication, Management

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4.6 (125 Bewertungen)

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CC

Apr 25, 2017

The case scenarios were so realistic that will make you think critically and apply the concepts you just learned.

PT

Sep 08, 2018

Very good content and effective quiz for checking ourselves more understanding of each chapter

Aus der Unterrichtseinheit

Mr. Osner Santana Meets Dr. Jefferson (Part 2)

New Models of Care Delivery0:00

Accountable Care Organizations23:46

ACO Performance0:00

The Patient-Centered Medical Home0:00

Unterrichtet von

Rita Kukafka
Associate Professor

Skript

Welcome to Value-Based Care, Healthcare Delivery.

This is Lecture c.

In this lecture, we describe how accountable care organizations, or

ACOs, are evaluated and performing.

We also introduce potential legal, ethical, and privacy issues for ACOs.

The objectives for this lecture, Accountable Care Organizations Lecture c,

are to describe the metrics used to evaluate ACO performance.

Discuss how ACOs are performing.

Describe potential legal and ethical issues facing ACOs,

and identify privacy issues in ACO models of care.

To summarize our discussion of ACOs, it is becoming increasingly apparent that

the provision of high quality care involves coordinated longitudinal care.

And that means accountability and

performance assessment at the individual provider level are no longer sufficient.

Especially when gaps in care are the result of poor coordination of care.

ACOs will need new processes and

tools and individuals with new skills to coordinate and improve care.

Individual providers often don't have the capital resources to invest,

nor do they have enough responsibility for the whole patient to look at the big

picture with regard to technology investment within the entire system.

By connecting physicians to a larger group,

they may be better able to connect and coordinate on behalf of their patients.

Although these new models of care are just beginning,

we need to give some consideration to how we can measure their impact.

One approach is to use a logic model, which is often used for

program evaluation as well as planning.

By documenting the context, environment, and inputs into the program, one can

anticipate the intermediate outcomes and ultimately the impact of the program.

There are many ways to assess the impact of ACOs.

Fisher employed the logic model concept to analyze ACO impact.

The figure on the screen provides a model for

understanding different aspects of ACO performance.

The ultimate measure of success of the ACO approach will be

assessing the three impact areas noted in the right-hand column in the figure.

Improved access and patient experience, improved health and

functioning of members and reduced costs of care,

these reflect what is known as the triple aim.

The second column to the right lists three important intermediate outcomes of ACOs.

The degree of health information technology achieved in ACOs,

the improvement in care processes and

the degree of care integration achieved by the ACO.

To achieve the desired impact and

outcomes of ACOs, it is becoming increasingly evident that ACOs

will need to do the things identified in the middle column of the figure.

That is, implement health information technology and health information exchange

across programs and across the different entities that make up the ACO.

Achieve robust data sharing by providers and with payers, and

develop the infrastructure to support public reporting on quality and

spending performance.

This section will focus on the potential ways ACO performance will be measured.

In this case, we will describe how ACOs will set spending targets and

quality of care benchmarks.

Recall that these two categories of measurement

are central to the values-based concept of the ACO.

This is different from traditional payment systems and

incentives that had been tied to the quantity or volume of care provided.

In most cases, ACO's spending performance is focused on measures

of the total cost of care for a defined set of patients.

In other cases, ACO's set spending targets related to a reduction in some measure,

such as the per member per month growth rate in spending.

The spending targets are risk adjusted,

which means that they are adjusted based on the chronic conditions and

other health measures of the patients served by physicians in the ACO.

We are just now beginning to see how ACOs are performing.

A study published in 2014 looked at the largest ACO program,

The Medicare Shared Savings Program ,and found mixed results among 220 ACOs.

About half of the ACOs met quality benchmarks and

kept spending below targets.

29 of these ACOs saved more than 2% and were eligible for sharing savings.

The ACOs received $126 million in savings and

generated $128 million in total savings for Medicare.

Slightly more ACOs, 60, did not meet their quality benchmarks or

did not reduce spending enough to share in savings.

These ACOs were able to keep total spending under the target level.

In subsequent years the results have been fairly consistent,

with overall spending reduced and, for the most part, quality indicators improving.

There are also mixed results in the Pioneer ACO Program.

In this program, there are savings generated and in some cases shared.

For instance, in year 1,

the program generated $147 million in total program savings.

In year 2 of this program, $96 million in total program savings

was generated and 11 ACOs received bonuses.

However, 3 of the ACOs faced penalties.

In each year, pioneer ACOs have left the program, most moving to the MSSP.

The quality of care measures used by ACOs in two of the Medicate ACO

models include 33 nationally recognized quality measures in

the four domains of patient/caregiver experience,

care coordination/patient safety, at-risk populations and preventive care.

We will now briefly present the measures

used to evaluate ACO quality of care performance.

For all measures,

more detailed descriptions can be found in the documentation Provided by CMS.

The Patient/Caregiver Experience domain includes eight indicators

that are all collected through patient and caregiver surveys.

The measures were developed by the Clinician and Group Consumer Assessment

of Health Care Providers and Systems, also called CG CAHPS.

ACOs must use CMS approved vendors to administer the surveys.

There are ten measures in the Care Coordination and Patient Safety domain.

This domain includes some of the most complex measures that will require

sophisticated systems for measurement, calculation, and reporting.

One example is risk-standardized all conditions re-admissions to hospitals.

Re-admission following acute care hospitalizations are costly, and

often preventable.

Medicare reports that almost 20% of Medicare beneficiaries

were readmitted within 30 days of discharge.

Others have estimated that reducing national Medicare readmission rates to

the level found in top-performing regions could save Medicare $1.9 billion annually.

Working together across multiple providers, and

focusing on local populations,

ACOs should be able to reduce the number of re-admissions for all conditions.

Another example in this domain is the percent of primary care physicians in

the ACO, who successfully meet meaningful use requirements.

Medicare focuses here, because health information technology has been

shown to improve the quality of care and the ability of the ACO to coordinate care.

The At-risk Population domain includes eight measures

focused on ACO patients in the following at risk populations,

coronary artery disease, diabetes, heart failure,

hypertension, ischemic vascular disease, and mental health.

In each at-risk population,

there are measures of various patient-care processes and outcomes.

These measures are intended to keep ACOs focused on improving the clinical care of

patients with these diseases.

They are collected through claims data.

The final domain of ACO quality measures focuses on preventive care.

The measures include things like immunizations and also screenings and

followup plans for conditions, such as obesity,

body mass index, tobacco use, high blood pressure, and clinical depression.

These measures are typically identified through data collected in clinical

information systems.

The challenges of managing care in an ACO cannot be met without

a significant investment in information technology.

The increase in adoption of EHR that was facilitated by the HITECH Act

of 2009 has paved the way for the kind of technology need for ACOs.

In an effort to meet the meaningful use criteria,

many providers began to use technology for clinical decision support,

health information exchange, and patient engagement.

Clinical decision support focused on the quality indicators.

Exchange of information across the ACO and

engagement of patients through patient portals or other means are all needed

to support care management, quality improvement and care coordination and

data sharing both among providers and between providers and patients.

Since ACOs must also monitor and report on their metrics

across a population of patients and across multiple provider entities,

a means of aggregating data and facilitating reporting is needed.

A data warehouse that ideally combines both cost and

clinical data can facilitate that reporting.

In addition, there are specialized applications like patient registries, for

instance, that would keep track of all patients with a given condition.

As well as specialized population health applications that facilitate

the monitoring and caring for a population.

The American Hospital Association identified several potential legal and

regulatory issues associated with ACOs.

The heart of the matter is how ACOs develop and share financial incentives and

rewards.

ACO arrangements could potentially be in violation of several federal laws,

including the Medicare ban or self-referrals, fraud and abuse statutes,

the Anti-Kickbacks statute, and the Civil Monetary Penalty Law.

In addition, nonprofit hospitals will need to make sure

ACO participation does not make them out of compliance

with the Internal Revenue Service guidelines for nonprofit institutions.

As ACOs have developed, many of these issues have been raised and

successfully overcome.

ACOs may also raise ethical issues for providers.

DeCamp and colleagues have outlined some of these issues,

including one issue is balancing health care providers' need to achieve cost

savings with patients' freedom to choose their health care providers.

Hospitals may need to balance the way they establish provider networks and

control physician referrals with the rights of patients to choose providers.

Focusing on preventing illness may lead to financial conflicts of interest for

the organizations.

As ACO models develop, quality indicators may give incentives for

hospitals to reduce unnecessary readmissions.

At the same time, hospitals may still receive more payment with more admissions.

These unintended financial effects may lead to difficult decisions for

hospital leaders.

There is also a risk that in focusing on specific quality measures,

less attention will be given to other aspects of quality care

that are not part of the required metrics.

ACOs will undoubtedly raise new questions about relationships,

what to focus on when Medicare requires 33 different quality of care measures,

and how benefits, that is savings, are distributed among providers.

Strong leadership and governance will be necessary to ensure appropriate responses

to these and other ethical issues that may arise as ACOs are implemented fully.

DeCamp and colleagues identify specific potential ethical issues

facing leaders, clinicians and patients in ACOs.

They also describe management strategies to appropriately manage and

overcome these ethical challenges.

For example, leaders who involve clinicians in the design of shared savings

plans may ameliorate the ethical issues of resource allocation and fairness.

Similarly, ACOs can monitor clinicians' experiences in the organization,

as it relates to potential perceptions of pressure to withhold care, or

up-code, in order to improve ACO financial performance.

Focused efforts to develop teams of providers, collaboration across primary

and specialty care, and communication strategies may also help

clinicians manage perceived competition among primary and specialty care.

Finally, ACOs can work to use proven patient engagement strategies

in the design and operations of ACO programs and services,

which would mitigate the conflicts between patient and provider needs.

It will be important for ACOs to make sure patient privacy is protected at all times.

This will be more challenging than ever as the ACO must share information across many

different providers and programs.

ACO participants are HIPAA covered entities.

That means they must manage protected health information, or

PHI, in compliance with HIPAA.

ACOs can address potential privacy issues by including privacy and

security obligations in all agreements.

By updating risk assessment and management plans.

By developing a strong breach response plan and by training their

workforce on these matters, particularly as they relate to information sharing.

If the Health Information Exchange mechanism is managed outside the ACO,

the ACO must assure that strong privacy and security protections

are in place before agreeing to contract with an outside entity.

This concludes Healthcare Delivery Lecture c.

In summary, CMS requires ACOs to report on 33 measures in four domains.

In terms of assessing how ACOs have performed,

there are many measures that can be used.

In general,

evaluations have found that the overall early performance of ACOs is mixed.

Many have achieve both equality and cost savings desired, but some have not.

As they develop further, ACOs must work to understand and

deal with potential legal, regulatory, ethical, and

privacy issues that will arise with this new model of care.

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