One-Fifth to Launch ‘Next Generation’ ACO in 2015

Twenty percent of healthcare organizations plan to participate in CMS’s new ‘Next Generation’ ACO model in the coming year, according to 2015 Accountable Care Organization metrics from the Healthcare Intelligence Network (HIN).

About one third of future Next Generation ACOs identified in HIN’s fourth comprehensive Accountable Care Organization survey are administered by physician-hospital organizations, with more than half reporting staffs of between 100 and 500 physicians.

In CMS’s Next Generation ACO model announced earlier this year, participants can take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings. Next Generation ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients, CMS noted.

Seventy percent of respondents to HIN’s ACO survey already participate in CMS’s popular Medicare Shared Savings Program (MSSP), while almost one-tenth have committed to the federal payor’s Advance Payment ACO, an innovative model designed for small physician practices or hospitals and doctors that work in remote rural areas.

The industry’s gradual shift to value-based reimbursement is reflected in HIN survey respondents’ favored payment model: 45 percent report a hybrid reimbursement formula of fee for service plus care coordination plus shared savings.

The 2015 ACO snapshot also identified the following accountable care metrics:

  • Data analytics pose the greatest challenge to ACO operations, say one-third of respondents.
  • Clinical outcomes are the ultimate measure of ACO success, say 80 percent of organizations surveyed.
  • Two-thirds of respondents credit improvements in care coordination to their ACO operations.
  • Telehealth is offered by 34 percent of responding accountable care organizations.

Administered in April 2015, HIN’s fourth comprehensive Accountable Care Organizations survey garnered responses from 110 healthcare organizations.

Source: Healthcare Intelligence Network May 14, 2015

2015 Healthcare Benchmarks: ACOs

2015 Healthcare Benchmarks: Accountable Care Organizations is HIN’s fourth annual compendium of metrics on ACOs, delivering actionable data on accountable care organizations from 110 healthcare companies who completed HIN’s April 2015 ACO activity assessment.

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Pioneer ACO Results Year 2: Inpatient Utilization Down; Medicare Saves More Than $384 Million

The Pioneer Accountable Care Organization (ACO) Model has generated over $384 million in savings to Medicare over its first two years — an average of approximately $300 per participating beneficiary per year — and significantly decreased inpatient care, while continuing to deliver high-quality patient care, according to HHS.

Initially established to further healthcare’s transition to value-based reimbursement and care for Medicare beneficiaries, the Pioneer ACO will be scaled into other Medicare programs, HHS states. The agency recently announced it will tie 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018. More than 3,600 payors, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Health Care Payment Learning and Action Network, which was launched to help the healthcare system reach these goals.

Currently, the Pioneer ACO Model serves more than 600,000 Medicare beneficiaries. According to the HHS, compared to their counterparts in regular fee-for-service or Medicare Advantage plans, Medicare beneficiaries who are in Pioneer ACOs, on average:

  • Report more timely care and better communication with their providers;
  • Use inpatient hospital services less and have fewer tests and procedures, and
  • Have more follow-up visits from their providers after hospital discharge.

Pioneer ACOs generated Medicare savings of $279.7 million in 2012 and $104.5 million in 2013. To date, actuarial analyses show that ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program have generated over $417 million in total program savings for Medicare. Primary analysis can be found in an article published in the Journal of the American Medical Association (JAMA).

Source: HHS May 4, 2015

Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care

Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care provides first-year advice from Monarch HealthCare’s Medicare accountable care organization, one of 32 original CMS Pioneer ACOs engaged to test alternative payment and program design models for accountable care organizations. Colin LeClair, executive director of ACO for Monarch HealthCare, recounts in this 30-page resource the challenges, results and learnings from its first 12 months as a Pioneer ACO, including the IPA’s interest in redefining care coordination boundaries.

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Evidence-Based Care, Obesity Among 15 ‘Vital Signs’ for Monitoring Nation’s Health: IOM Report

Tracking 15 core measures, including evidence-based care and obesity, are crucial for assessing and monitoring the nation’s health, according to a new report from the Institute of Medicine (IOM). Progress in these vital signs—or core measures— should reduce the burden on clinicians of taking measurements, enhance transparency and comparability, and improve health outcomes nationwide.

While the nation’s healthcare costs and expenditures are the highest in the world, health outcomes and the quality of care are below average by many measures, study authors note. The proposed core set focuses on the most powerful measures that have the greatest potential to positively affect the health and well-being of Americans.

Although not intended to replace the full range of measures in use today, the set of 15 vital signs are expected to evolve over time, keeping pace with the needs and capabilities of the health system. They are:

  • Life expectancy;
  • Well-being;
  • Overweight and obesity;
  • Addictive behavior;
  • Unintended pregnancy;
  • Healthy communities
  • Preventive services;
  • Access to care;
  • Patient safety;
  • Evidence-based care;
  • Care that matches patient goals;
  • Personal spending burden;
  • Population spending burden;
  • Individual engagement; and
  • Community engagement.

Renewed attempts to align health measures in order to reduce redundancies and inefficiencies may now succeed because of significant changes in the measurement environment, most notably with growing data capture capabilities from widespread use of electronic health records (EHRs) and other digital tools, the committee said. The emerging health information technology (HIT) infrastructure could support a real-time measurement system for routine collection of information, and it provides an opportunity to measure what matters most, enabling goals to drive measures as a replacement for measures that drive goals.

The report calls for specific actions for different stakeholder groups to help ensure the adoption and implementation of the cores measures. In particular, the committee recommended that the secretary of the U.S. Department of Health and Human Services (HHS) should use the set of core measures to sharpen the focus and consistency and reduce the number and burden of measure reporting in HHS programs. In addition, the secretary of HHS should develop and implement a strategy for working with other federal and state agencies and national organizations to facilitate the use and application of the core measure set.

Health measurements are requested and required by organizations for various purposes, but many of the individual measures in use today were developed without attention to the broader context. Measurements often overlap or are redundant and are implemented for a particular purpose and circumstance. For example, the Centers for Medicare and Medicaid Services’ (CMS) measure inventory catalogs nearly 1,700 measures, and the National Quality Forum’s measure database includes 630 measures. While several of these measures are of high quality and provide valid and useful information, most examine slight variations of the same target information and differ enough to prevent direct comparisons among the states, institutions, or individuals, the committee said. Moreover, measures focused only on limited component issues cannot reliably reflect the nation’s overall health system performance.

Source: National Academy of Sciences April 28, 2015

2014 Healthcare Benchmarks: Population Health Management

2014 Healthcare Benchmarks: Population Health Management delivers an in-depth analysis of population health management (PHM) trends at 129 healthcare organizations, including prevalence of PHM initiatives, program components, professionals on the PHM team, incentives, challenges and ROI.

Posted in affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Care Coordination, Disease Management, Elderly Care, electronic health records (EHRs) | Tagged , , , | Leave a comment

Better Communication Key to Lowering Healthcare Costs, Improving Patient Experience: Survey

Strengthening communication between caregivers and patients should be a top priority for reducing healthcare costs and improving patient experience, according to a new poll of U.S. healthcare quality improvement professionals conducted by ASQ, a global network of resources and experts.

Payment and regulatory systems and fragmented care were cited as top hurdles in achieving patient-centered care, researchers noted. Fragmented communication between care sites was also cited as a top barrier to efficient transitions of care for respondents to the Healthcare Intelligence Network’s fourth comprehensive Care Transition Management survey, conducted in February 2015. Technology offered a leg up by way of telehealth and remote monitoring, respondents said; 75 percent of respondents said they transmitted patient discharge or transition information via electronic medical records (EMRs).

ASQ survey participants ranked the following factors as key to improving patient experience as well as reducing costs and increasing profitability for healthcare organizations:

  • Strong leaders who prioritize a patient-centered philosophy among staff and promote an organized system where patients know what to expect and when (67 percent);
  • Viewing patient experience and service delivery as equal priority to financial and clinical performance measures (60 percent); and
  • Ease of access to treatment across the entire continuum of care (via accountable care organizations, etc.) (52 percent).

ASQ researchers cited recent studies that found that physicians spent less than 10 minutes with patients during an office visit.

Source: ASQ, April 16, 2015

Accountable Care Strategies to Improve Hospital-SNF Care Transitions

Accountable Care Strategies to Improve Hospital-SNF Care Transitions provides a look at a health system-SNF network that has curbed rehospitalizations and length of stay for participants. In this 25-page resource, Summa Health System shares how it rallied 40 independent skilled nursing facilities (SNF) to form a network that has elevated its hospital-to-SNF transfers of care, reducing readmissions and length of stay for Summa patients released to SNFs in the process.

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Senate’s Repeal of Medicare Sustainable Growth Rate Strengthens Move Toward Value-Based Physician Reimbursement

The U.S. Senate voted Tuesday, April 14th, to approve a bill that repeals the Medicare Physician Payment Reform Bill, otherwise known as the Sustainable Growth Rate (SGR), a mechanism used to calculate Medicare payments to physicians.

The legislation also created the Merit-Based Incentive Payment System further solidifying Medicare’s move toward payment systems based on quality. The bill was signed into law by President Obama. The National Quality Forum (NQF) applauded the move, as did many other physician organizations.

The legislation complements the recent launch by the U.S. Department of Health and Human Services (HHS) of the Health Care Payment Learning and Action Network, with its focus on shifting payments for healthcare services based from one that rewards volume of services to one that rewards value of services provided.

Says the NQF, “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”

Source: NQF, April 15, 2015

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenuesets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements. Attorneys Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, drill down into chronic care management requirements outlined in the 2015 Medicare Physician Fee Schedule.

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EDs Seeing More Patients with Complex, Chronic Conditions, Mental Illness; Fewer Injuries

The rate of emergency department (ED) visits in California for non-injuries has risen while the rate of visits for injuries has dropped, according to a new study led by UC San Francisco that documents the increasing amount of care provided in ED for complex, chronic conditions.

The research, which appears in the April edition of Health Affairs, shows that the ED visit rate for injuries decreased by 0.7 percent during the study’s timeframe — from 2005 to 2011 — while the rate of ED visits for non-injury diagnoses rose 13.4 percent. Among non-injury diagnoses, gastrointestinal system diseases, nervous system disorders, and symptoms of abdominal pain experienced the highest growth in the rate of ED visits, the study found.

The research shows the growing importance of non-trauma cases in the ED, the authors said, and it provides an opportunity to better understand the health of people as well as shifting patterns of care, especially among vulnerable populations.

Other key findings from the study include the following:

  1. While the rate of ED visits for injuries rose more slowly than non-injury diagnoses among Medicaid beneficiaries and the privately insured, the rate decreased among the uninsured.
  2. Medicare beneficiaries had a similar percent growth for injury and non-injury diagnoses. Younger patients 5-44 years old experienced more non-injury related diagnoses, compared to the older population (45 and older) who had more injury-related diagnoses.
  3. The rate of growth in mental health conditions as a primary diagnosis was significant among the uninsured, Medicare beneficiaries, and the privately insured, showing the ED is also serving as a place of care for patients with mental illness.

The research shows the complexity of emergency care, and it may help policy makers and emergency care physicians to reshape the structure, staffing and funding of emergency departments, the researchers conclude.

Source: UCSF April 6, 2015

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge. This 25-page report reviews the multi-state and international integrated delivery network’s impressive early returns in cost of care, 30-day readmission rates and patient satisfaction, as well as challenges of program expansion.

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Mental Health Disorders Complicate Standards for Readmissions

Co-existing psychiatric illness should be considered in assessing hospital readmissions for three common medical conditions used by Medicare and Medicaid to penalize hospitals with “excessive” readmission rates: heart failure, acute myocardial infarction (AMI) and pneumonia, according to a new collaborative study by 11 major U.S. healthcare providers affiliated with the nationwide Mental Health Research Network (MHRN). The study is published in Psychiatric Services.

Hospital readmissions account for a large share of healthcare spending in the United States, including more than $17 billion of Medicare costs each year. In attempting to reduce excessive readmissions — those occurring within 30 days of a patient’s original hospitalization — CMS is expected to add other medical conditions to the three already used as standards.

Psychiatric illness was already known to be highly comorbid with heart failure, AMI and pneumonia.

The study identified more than 160,000 patients who had been admitted to the 11 MHRN-affiliated healthcare centers between January 2009 and December 2011 for any of the three medical conditions targeted by CMS. It was the largest and most geographically diverse investigation of its kind.

Researchers found that patients with psychiatric comorbidities in the previous year were readmitted to the hospital 3 to 5 percent more often within 30 days than those without a psychiatric diagnosis. They also noted that nearly 30 percent of those admitted to the hospital with heart failure, AMI or pneumonia were diagnosed in the previous year as having a mental health condition.

Most important, the study concluded, individuals with a psychiatric concern probably accounted for an even larger proportion of admissions for heart failure, AMI or pneumonia, but because mental health conditions are often not diagnosed, these illnesses weren’t captured in medical records.

The study was conducted by researchers in the Mental Health Research Network (MHRN), a consortium of 13 large healthcare systems with affiliated health insurance plans. The MHRN systems serve over 12.5 million individuals across 15 states with diverse populations. Sites participating in this study and their primary locations included Group Health Cooperative (Washington), Harvard Pilgrim Health Care (Massachusetts), HealthPartners (Minnesota), Henry Ford Health System (Michigan), Kaiser Permanente (Colorado), Kaiser Permanente (Georgia), Kaiser Permanente (Hawaii), Kaiser Permanente Northern (California), Kaiser Permanente Northwest (Oregon), Kaiser Permanente Southern (California), and Baylor Scott & White Health (Texas). Institutional review boards at each site approved data use for this project.

Source: Henry Ford Health System March 25, 2015

Reducing Behavioral Health Readmissions: Integrating Behavioral and Physical Health for a Broad-based Intervention

Reducing Behavioral Health Readmissions: Integrating Behavioral and Physical Health for a Broad-based Intervention presents Carole Taylor, MSN, RN, chief clinical officer, and Shari Hutchison, Manager, Outcomes Department, both with Community Care Behavioral Health Organization, who will share Community Care’s strategies and interventions to reduce both physical health and behavioral health readmissions during this 45-minute webinar on June 11th.

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Humana Accountable Care Snapshot: Reduced Readmissions Among Value-Based Results

Improving access to accountable care is one of four improvements Humana disclosed from ongoing programs to improve quality and reduce costs for Medicare beneficiaries, according to Humana.

Humana disclosed results to date from initiatives to foster value-based reimbursement in the traditional, fee-for-service (FFS) Medicare program in conjunction with the Health Care Payment Learning and Action Network launched by the White House. The Learning Network supports HHS’s recently announced timeline for shifting Medicare payments to alternative payment models such as Accountable Care Organizations (ACOs), patient-centered medical homes or bundled payment arrangements.

Humana’s quality and cost improvements to date include the following:

  • Improving Access to Accountable Care: While HHS aims to have 30 percent of Medicare payments in alternative payment models by the end of 2016 and 50 percent by the end of 2018, Humana has 53 percent of its members in accountable care relationships today and is on course to have more than 75 percent in accountable care relationships by 2017.
  • Improving the Quality of Patient Care: Humana’s accountable care relationships are improving the quality of patient care delivered to its health plan members. In 2014, Humana’s accountable care providers had a Healthcare Effectiveness Data and Information Set (HEDIS) Star score average of 4.25 as compared to providers outside of accountable care settings with a HEDIS Star score average of 3.65.
  • Reducing Hospital Readmissions and ER Visits: While HHS has reduced the Medicare fee-for-service hospital readmission rate from 19 percent in 2011 to 17.5 percent in 2013, Humana members in accountable care relationships have a 4 percent lower hospital readmission rate than traditional, fee-for-service Medicare and 7 percent fewer emergency room visits per thousand beneficiaries.
  • Lowering Costs: Humana experienced a 19 percent cost improvement in total in 2013 for members who were treated in an accountable care setting compared with members who were treated by providers in original Medicare settings.

Source: Humana March 25, 2015

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology draws from initiatives at WellPoint, Highmark, BCBS Michigan, and advice from Optum, Navigant, Healthcare Strategy Group and others, structuring experts’ give-and-take in an easy-to-follow Q&A format.

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Physicians Need Help with Details, Data Management in New Value-Based Payment Models: Study

As value-based healthcare payment models continue to surge, physician practices need help managing increasing amounts of data and responding to the diversity of programs and quality metrics from different payors, according to a new joint study by the RAND Corporation and the American Medical Association (AMA).

The alternative healthcare payment models include episode-based and bundled payments, shared savings, pay-for-performance, capitation and retainer-based practices, accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) all intended to improve quality and reduce costs.

Many physician practices are responding by partnering or merging with other medical practices or hospitals in order to better support the investments necessary to succeed in new payment models, such as care managers and information technology, according to researchers. Practices say that realigning their operations to the goals of the new payment strategies can be challenging when necessary data are not available or different payment models conflict with each other.

Researchers performed case studies of 34 physician practices in six diverse geographic markets to determine the effects that alternative healthcare payment models have on physicians and medical practices in the United States.

Key findings of the study include the following:

  • Among the practices surveyed, none had experienced financial hardship as a result of involvement in new payment models.
  • Physicians generally agreed the transition encouraged collaborative team-based care to prevent the progression of disease, and increased access to care and physicians through telehealth or community-based care.
  • Physicians were supportive of new patient registries that list patients with certain health conditions as a way to improve care. But they had concerns about documentation requirements where the link to better care was less clear.
  • The operational details of alternative payment models can either help or hinder practices’ efforts to improve their own processes. For example, practices are investing significantly in information systems to analyze large amounts of data about practice patterns. But when crucial data (like quality performance feedback and drug prices) are missing or inaccurate, it is difficult for physician practices to use data analysis to improve care and reduce spending.
  • While physician practices are making substantial investments in data collection, payors also should consider investing in the capability of physician practices to manage the information. Such investments could enhance the effectiveness of new payment models, and help medical practices make the best use of computerized health records and other health information technology, according to researchers.
  • In addition, payors should consider ways to harmonize key components of alternative payment models, especially performance measures. Medical practices usually contract with many payors, who each may have different performance measures tied to payment rewards. So medical practices must cope with how to address hundreds of performance measures and create a coherent response.

Researchers also found that most medical practices have shielded individual physicians from direct exposure to the new financial incentives created by payors. While practices are paid more for improved performance, practices generally use nonmonetary incentives to encourage physicians to change their decision-making. Those methods include efforts such as providing performance feedback to individual doctors and are intended in many cases to appeal to physicians’ sense of professionalism.

The study found alternative payment models generally have not changed the core content of physicians’ clinical work. Efforts to improve efficiency by delegating some tasks to non-physicians had the unintended consequence of increasing the intensity of physicians’ work, raising concerns about burnout.

Source: RAND Corporation March 12, 2015

Physician Value-Based Reimbursement: Quality Rewards for Population Health

Physician Value-Based Reimbursement: Quality Rewards for Population Health describes the four tiers of Humana’s Physician Quality Rewards program as well as the support, training, technologies and outcomes associated with these pay-for-value relationships.

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‘Next Generation’ ACO Encourages Telehealth, Post-Discharge Home Services: CMS

In another step towards advancing models of care that reward value over volume, HHS announced the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. A new initiative from CMS’s Innovation Center, the model is part of the agency’s plan to move an increasing percentage of Medicare of Medicare payments into models that support value-based care, and supports a number of tools including telehealth and post-discharge home services.

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (MSSP), the Next Generation ACO Model is designed to set predictable financial targets, enable providers and beneficiaries greater opportunities to coordinate care, and attain the highest quality standards of care, according to HHS.

The ACOs in the Next Generation ACO Model will take on greater performance risk than ACOs in current models, while also potentially sharing in a greater portion of savings. To support increased risk sharing, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure that provides high quality care to patients.

The new ACO model encourages greater coordination and closer care relationships between ACO providers and beneficiaries. ACOs will have a number of tools available to enhance the management of care for their beneficiaries. These tools include the following:

  • Rewards to beneficiaries for receiving their care from physicians and professionals participating in their ACOs;
  • Coverage of skilled nursing care without prior hospitalization;
  • Modifications to expand the coverage of telehealth and post-discharge home services to support coordinated care at home.

The Next Generation ACO Model also supports patient-centered care by providing the opportunity for beneficiaries to confirm a care relationship with ACO providers and to communicate directly with their providers about their care preferences.

CMS will accept ACOs into the Next Generation ACO Model through two rounds of applications in 2015 and 2016, with participation expected to last up to five years. Organizations interested in applying in 2015 must submit a Letter of Intent by May 1, 2015, and an application by June 1, 2015. Second round Letters of Intent and applications will be available in spring 2016.

Source: HHS March 10, 2015
Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population

Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population reviews Humana’s expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Care Coordination, Care Transitions, Disease Management, dual eligibles, Elderly Care, Healthcare Costs, Healthcare Utilization, Home Healthcare, Medicare/Medicaid EHR Incentive, Skilled Nursing Facilities, Telehealth | Tagged , , , , | Leave a comment