Archive for the ‘Accountable Care Organizations’ Category

Infographic: Improving Health Literacy with Data

May 10th, 2017 by Melanie Matthews

Individuals are not solely responsible for increasing their health literacy, healthcare organizations are accountable too, according to a new infographic by Sagitec.

The infographic examines health literacy trends, implications, possibilities and solutions.

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health SystemIntermountain Healthcare's strategic six-point patient engagement framework not only has transformed patient care delivered by the Salt Lake City-based organization but also has fostered an attitude of shared accountability throughout the not-for-profit health system.

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health System details Intermountain's multilayered approach and how it supports its corporate mission: Helping people live the healthiest lives possible.

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CMS Quality Payment Program: Clinicians Should Expect MIPS Participation Status Letter This Month

May 4th, 2017 by Melanie Matthews

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CMS has specified two key criteria for MIPS participation.

The Center for Medicare and Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), according to information on MLNConnects, the CMS Medical Learning Network.

MIPS is an important part of the new Quality Payment Program (QPP). In late April through May, clinicians will get a letter from their Medicare administrative contractor that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with their Taxpayer Identification Number (TIN).

Clinicians should participate in MIPS in the 2017 transition year if they meet the following conditions:

  • Bill more than $30,000 in Medicare Part B allowed charges a year; and
  • Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year.

The QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate (SGR) formula and streamlines the “Legacy Programs:” Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program.

During this first year of the QPP program, CMS said it is committed to working with clinicians to streamline the process as much as possible. The federal payor stated that its goal is to further reduce burdensome requirements so that providers can deliver the best possible care to patients.

Infographic: Healthcare Scorecards Versus Dashboards

April 3rd, 2017 by Melanie Matthews

Healthcare organizations use scorecards and dashboards to measure and sustain outcomes improvement, according to a new infographic by HealthCatalyst.

The infographic examines how organizations use dashboards versus scorecards and the key features of each.

2016 Healthcare Benchmarks: Data Analytics and IntegrationThe 2016 Healthcare Benchmarks: Data Analytics and Integration assembles hundreds of metrics on data analytics and integration from hospitals, health plans, physician practices and other responding organizations, charting the impact of data analytics on population health management, health outcomes, utilization and cost.

2016 Healthcare Benchmarks: Data Analytics and Integration examines the goals, data types, collection processes, program elements, challenges and successes shared by healthcare organizations responding to the January 2016 Data Analytics survey by the Healthcare Intelligence Network. Click here for more information.

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How a Data Dive Makes a Difference in ACO Care Coordination Efficiency

March 30th, 2017 by Patricia Donovan

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UTSACN used data analytics to trim its home health network from more than 1,200 agencies to 20 highly efficient home health providers.

How does UT Southwestern Accountable Care Network (UTSACN) use information to inform and advance care coordination programming? As UT Southwestern's Director of Care Coordination Cathy Bryan explains, a closer look at doctors' attitudes toward a Medicare home health form initiated a retooling of the ACO's home health approach.

We realized our home health spend was two times the national average. When we reviewed just the prior 12 months, we identified more than 1,200 unique agencies that serviced at least one of our patients. With this huge number of disparate home health agencies, it was difficult to get a handle on the problem.

Our primary care doctors told us they found the CMS 485 Home Health Certification and Plan of Care form to be too long. The font on the form is four-point type; it's complex, so they don't understand it. However, because they don't want a family member or patient to call them because they took away their home care, they often sign the form without worrying about it.

As we began looking at these findings, we wondered what they really told us. Are some agencies better than others, and how do we begin to create a narrow network or preferred network for home care? We knew we couldn't work with 1,200 agencies efficiently; even 20 agencies is a lot to work with.

We began to analyze the claims. My skilled analyst created an internal efficiency score. She risk-adjusted various pieces of data, like average length of stay. For home health, there were a number of consecutive recertifications. We looked at average spend per recertification, and the number of patients they had on each agency. We risk-adjusted this data, because some agencies may actually get sicker patients because they have higher skill sets within their nursing staff.

We created a risk-adjusted efficiency score based on claims. We narrowed down the list by only looking at agencies with 80 percent or higher efficiency. That left us with about 80 agencies; we then narrowed our search to 90 percent efficiency and above, and still had 44. That was still too many, so we cross-walked these with CMS Star ratings to narrow it even more. Finally, after looking at our geographic distribution for agencies that serviced at least 20 patients, we eliminated those with one and two patients. We sought agencies that had some population moving through them.

Ultimately, we reduced our final home health network to about 20 agencies that were not creating a lot of additional spend, and not holding patients on service for an incredibly long period of time.

Source: Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives

advanced care coordination

During Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives, a 2016 webinar available for replay, Cathy Bryan, director, care coordination at UT Southwestern, shares how her organization’s care coordination model manages utilization while achieving its mission of bridging the gap from where patients are to where they need to be to adhere to their care plan.

Infographic: Top Accountable Care Organizations

March 24th, 2017 by Melanie Matthews

There are over 700 accountable care organizations (ACOs) across the country, according to a new infographic by SK&A, with California leading the way with the most ACOs.

The infographic examines each state's ACO ranking by the number of ACOs as well as the top five ACOs by the total number of participating physicians.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO's cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO's highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann's carefully executed journey to quality and the culmination of the ACO's community-based care management program.

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5-Part Framework for MIPS Success Under MACRA

March 2nd, 2017 by Patricia Donovan

Before picking MACRA pace, physician practices should construct a framework for MIPS success.

Along with picking a MACRA pace, physician practices should construct a framework for MIPS success.

Regardless of the pace a healthcare organization sets for Quality Payment Program participation, there are some key tactics that should form the framework of any MACRA initiative. Here, William Holding, consultant with PDA Inc., outlines the critical elements organizations need to achieve "MACRA-readiness."

  • The first component for success is perhaps the most important, and that's having a culture of provider support. A willingness to explore new options. This component is free, so if you don't have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you've got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
  • Second is strategic planning. Set measurable goals. That's important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
  • The next piece is strong leadership. If you don't have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.

    I've experienced teams that didn't work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You've got to find the right people to be involved.

  • Next, data analytics is key. This starts with an individual with the right skills. It doesn't mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
  • Lastly, clinical documentation is essential. Doing that well will improve your position in this program.

Source: Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance

social determinants of health

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

Physician Supplemental QRUR: Episode-Specific Patient-Level Data Tells Story of High Utilizers

February 7th, 2017 by Patricia Donovan

QRUR reports provide a mirror into physicians' cost and quality performance under MACRA.

As year one of MACRA unfolds, healthcare providers deterred by security hurdles associated with CMS Enterprise Portal access may want to reconsider. The wealth of aggregate quality and cost performance data available through the portal is well worth the trouble of accessing it, advises William Holding, consultant with PDA, Inc.

Specifically, Quality Resource and Utilization Reports (QRURs) downloadable from the portal are essential tools for physician practices that hope to succeed on MACRA-defined reimbursement paths, Holding said—even practices equipped with robust internal reporting systems.

"This is the same system that accountable care organizations (ACOs) use, and that CMS uses for many other things, so it's a good idea to get past those barriers," he explained during Physician MACRA Preparation: Using QRUR and Other CMS Data to Maximize Your Performance, a February 2017 webinar now available for replay.

Originally designed for CMS's value-based modifier, QRURs are good indicators of future cost performance under MACRA, via either Merit-Based Incentive Payment System (MIPS), where most physician practices are expected to fall initially, or Alternate Payment Models (APMs), he said.

After providing an overview of MIPS and APMs, including five essential prerequisites to MACRA preparation, Holding delved into the quality and cost metrics contained in QRURs, from aggregate data in the main report to detailed tables rich with patient-specific information.

The main QRUR report illustrates where a physician practice falls in relation to other practices on the overall composite for cost and quality. The QRUR's Quality portion shows scores for a series of domains, including effective clinical care and patient experience, which offer a great window into how a practice might perform with different selected measures in MIPS.

Next, QRUR cost performance indicates per capita costs for attributed beneficiaries, which will remain a cost measure in MIPS.

Drilling down, Holding characterized seven associated QRUR downloads—including one table on individual eligible professional performance on the 2015 PQRS Measures—as even more useful than the QRURs themselves.

And finally, he termed the downloadable supplemental QRUR "a very powerful tool" that drills down to the beneficiary level, providing a snapshot of some of the highest cost events occurring among a practice's patients.

"For high utilizers, for specific episodes, you can drill right down to the patient to try and understand the story. What's happening to your patient when they're not in your practice, and what can you do about it?" said Holding.

Having presented the available reports, Holding described four key benefits of using QRUR downloads, including as a priority setting tool, and then detailed the myriad of ways QRURs can be analyzed to improve MIPS performance.

However, Holding stressed, even physician practices with the most sophisticated reporting structures will not thrive under MACRA without the right team or culture of provider support in place. He closed his presentation with a formula for determining investment in performance improvement activities and a five-step plan for MACRA preparation.

Listen to an interview with William Holding on the use of QRURs to determine a physician practice's highest value referral pathways.

AMITA Health Places Patient at Center of Care Management Redesign

February 2nd, 2017 by Patricia Donovan
AMITA Health care management redesign

AMITA Health's care management redesign began in one patient unit on one floor.

In rolling out a new connected care management strategy across its nine-hospital system, AMITA Health aimed to keep its target patient population at the heart of the initiative—unit by unit, floor by floor. Here, Susan Wickey, vice president, quality and care management at AMITA Health, shares one of the guiding principles of the Medicare Shared Savings Program Accountable Care Organization (MSSP ACO).

The key component for us in our redesign was making sure that the patient was at the center of everything we did. With that in mind, we developed structured processes and programs that would span the care continuum while retaining the patient at the center. We wanted to establish relationship-based care with the patient and the primary care physician. We wanted to be able to use available data to help drive our decisions. We wanted to ensure that our patients had regular access to care, and that we leveraged what we currently had in place.

Our congestive heart failure clinic was key in this process. Navigating through the care continuum is not an easy process for many of our patients. We wanted to make sure we could help them through that, and construct some processes for them to be able to navigate. We wanted to make sure we were continuing to build the health literacy of our patients and our families. We wanted to establish interventions for the most vulnerable population of patients. We wanted to make sure we had a dedicated, multidisciplinary team to help us. We had psychiatrists, dieticians, pharmacists, primary care physicians and physician champions along the way to help us.

We began implementation very slowly, starting with a specific cohort of patients on one specific unit. This cohort was small; the number of people touching the cohort at the time was small. As we went along, we were able to define problem areas where we needed to intervene, quickly readjust and then go down the right path.

Slowly, over a period of time, we were able to add additional floors in our acute care hospitals, which then meant adding additional staff. Those additional staff then became the super users who helped us roll out the program on the next floor.

Source: Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations

Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations

Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations describes how the nine-hospital system inventoried, reexamined and revamped its care management resources, ultimately implementing a centralized care management model.

Infographic: ACO Trends

January 23rd, 2017 by Melanie Matthews

Momentum in value-based care has been building over the last several years, and 2016 was no exception, according to a new infographic by Oliver Wyman.

The infographic maps out the more than 630 ACOs in the United States.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO's cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO's highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann's carefully executed journey to quality and the culmination of the ACO's community-based care management program.

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Infographic: Maternity Episodes of Care

January 16th, 2017 by Melanie Matthews

Maternity Episodes of CareThe cost of maternity care varies significantly by payer (commercial or Medicaid), by type of birth (vaginal or cesarean section), and by setting (hospital or birth center). Too often, women are not experiencing optimal outcomes in maternity care despite the significant resources spent, according to a new infographic by the Health Care Payment Learning & Action Network.

The infographic examines how an episode of care could be applied to maternity care—from an episode timeline for prenatal through postpartum care; episode parameters; operational considerations; and maternity care design elements.

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has awarded $3 million to 51 specialty medical practices as part of a shared savings arrangement through the company's Episodes of Care (EOC) program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. As the largest commercial payor of Episodes of Care in the United States, Horizon BCBSNJ recently reported far lower hospital readmission rates and improved clinical outcomes for members in its EOC practices versus non-EOC practices in 2014.

During Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, a March 31, 2016 webinar, available for replay, Lili Brillstein, director of the Horizon EOC program, shares the details behind the health plan's EOC program, from the episodes they have bundled to the goals and results from the program.

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