- In 2016, CMS expects 30 percent of Medicare fee-for-service (FFS) reimbursement to be tied to alternative payment models such as accountable care and bundled payments.
- Also this year, the federal payor wants 85 percent of Medicare FFS payments to be based upon quality metrics.
"If you are a provider, or working with providers who accept Medicare beneficiaries, it's really important to know these changes are coming," advises Elena Tkachev, director of ACO analytics for Collaborative Health Systems (CHS). "It will be the responsibility of physicians to participate in these payments because no matter what happens, this change is coming."
Ms. Tkachev detailed the power of data analytics to drive CHS's success in accountable care during Data Analytics in Accountable Care: Strategies and Case Studies, a January 2016 webinar from the Healthcare Intelligence Network now available for replay.
As the largest sponsor of Medicare Shared Savings Program (MSSP) ACOs in the United States, CHS has a firm handle on HHS's value-based agenda. The organization manages 24 MSSP ACOs, nine of which generated savings of nearly $27 million in 2014, and one that has been accepted as a Next Generation ACO, the newest Medicare accountable care model.
And with CMS expectations for value-based reimbursement slated to rise over the next two years, expectations for data analytics to improve care and costs related to Medicare beneficiaries have never been higher.
"Today, physicians are being measured through claims and the clinical metrics on the population they serve. We see the main responsibility of analytics as providing simple access to actionable, timely and relevant information to help clinicians make better decisions, improve quality of care and enhance the patient experience."
Despite the magnitude of its enterprise, CHS believes its future in accountable care rests upon its primary care physicians (PCPs), which it views as "quarterbacks of care" for its more than 280,000 Medicare beneficiaries.
To foster quality improvement, CHS equips PCPs with an arsenal of analytics capabilities. So that its 3,200 providers can tap into CHS's massive storehouse of CMS, claims, lab, risk stratification and care coordination data collected on its 24 Medicare Shared Savings Program (MSSP) ACOs, the health system recently rolled out an analytics and dashboard portal.
These tools enable providers to monitor the aggregate health of their populations as well as their own performance, even giving providers the ability to track their own performance over time and contrast it with other clinicians'—a capability that pleases CHS's more competitive physicians, Ms. Tkachev notes.
Frequent webinar training keeps provider analytics' use sharp, and dashboard-generated reports and scorecards help physicians to monitor and enhance quality performance and improve patient outreach, Ms. Tkachev explained.
Despite its significant success, CHS still encounters the perennial challenges of access to timely and accurate data, aggregation abilities, and the display of meaningful results. Ms. Tkachev shared some CHS tactics to resolve these issues, including soliciting feedback on the tools from providers who use them.