Posts Tagged ‘ACO’

Rectifying System Disparities within ACO Improves Data Capture, Quality Reporting

October 30th, 2014 by Cheryl Miller

Addressing the disparity between data systems was one of the operational and information technology (IT) issues the John C. Lincoln (JCL) Accountable Care Organization (ACO) addressed at the end of its first year as a Medicare Shared Savings Program (MSSP) ACO, says Karen Furbush, business consultant with JCL ACO. Here she explains the steps taken to rectify the situation.

I was brought on board in July 2012 and was given the ‘playbook,’ or answers that John C. Lincoln provided to the Centers for Medicare and Medicaid Services (CMS) on how they would structure their ACO over the next three and a half years. It was my job to figure out from the IT perspective how to address all the new advancements with the Transition Coach program.

My job was to figure out this new EMR EPIC® system that was being installed, and how we were going to get data back out. It took us a while once we got our membership list from CMS to find addresses and do the mailing, which we decided to do. This is not required, but we wanted to get the information out to patients about what an ACO was; that we were now providing their basic primary care physician (PCP) services. And we wanted to communicate that as early as we possibly could.

Along with doing those initial mailings, we determined any additional data we needed from our system in order to respond to CMS reporting requirements for 33 quality measures. We took a two-day workshop in November 2012 and realized that not everyone was on the same EMR at the very beginning.

We have a lot of disparity between systems; not all data comes from one system to the next, due to business decisions. We had to go back and determine what we needed from each different system and how long this was going to take. Then we had to figure out how we would normalize or make sure that this data was specific for reporting back to CMS.

In this two-day workshop, we broke it down measure by measure. There are 15 different categories in which CMS places all of their reporting. We went through each — for example, for the emergency area, the hospital and in the physician practices — and asked ourselves what we were doing for each. Just because you’re on one EMR doesn’t mean the data capture model is the same. But I still needed to account for every time those things occurred; they are discretely reportable. That’s not always easy; even though you’re on one single platform, there are a lot of factors that play into why that’s very difficult to get to.

Source: Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care

http://hin.3dcartstores.com/Beyond-the-EMR-Mining-Population-Health-Analytics-to-Elevate-Accountable-Care_p_4900.html

Karen Furbush is a business consultant with John C Lincoln (JCL) Accountable Care Organization in Phoenix. She is responsible for coordinating and managing all things related to IT integration, data analysis and reporting for JCL’s CMS MSSP ACO and Employee ACO programs. She has over 20 years of technical program and IT management experience, and has held a wide variety of information technology roles in the healthcare industry.

Infographic: The Game of ACO

June 11th, 2014 by Jackie Lyons

The accountable care movement shows no signs of slowing, with more and more healthcare organizations choosing to join an accountable care organization (ACO). The first step to becoming involved in an ACO is identifying community partnerships and building relationships, especially with primary care, according to a new infographic from the National Council for Behavioral Health.

This infographic defines an ACO and outlines all the necessary steps and benefits to becoming involved in an ACO.

Want to know more about accountable care organizations? 2013 Healthcare Benchmarks: Accountable Care Organizations documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year’s respondents.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Critical Factors in Developing ACOs and PHOs

May 14th, 2014 by Jackie Lyons

The number of accountable care organizations (ACOs) led by a physician-hospital organization (PHO) nearly doubled over the last year, according to the third annual ACO survey conducted by the Healthcare Intelligence Network. Properly developing and operating these integrated heath systems is critical for healthcare organizations.

Highly effective leadership, sustained organizational committees and adequate up-front capitalization are just some of the key elements to the success of an integrated heath system, according to a new infographic from Mercury Advisor Group. This infographic identifies five key elements, along with detailed descriptions of each.

Want to know more accountable care trends? 2013 Healthcare Benchmarks: Accountable Care Organizations documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year’s respondents.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Physician Group ACOs Value Specialists, Nurse Practitioners

March 19th, 2014 by Jessica Fornarotto

As the number of public and private accountable care organizations nears 500, participants are fine-tuning the ACO model. In the few years since the ACO model entered healthcare’s consciousness, administration has shifted from hospital-led to physician-only leadership to PHO-helmed ACOs. In its third annual industry survey on ACOs, conducted in 2013, the Healthcare Intelligence Network captured how 138 healthcare organizations are participating in ACOs.

Drilling down to the multi-specialty physician group perspective, this survey analyzed the number of existing ACOs for this sector, which providers participate in the ACO, and more.

With their built-in cadre of healthcare providers, multi-specialty physician groups (referred to here as physician groups), which comprised about a tenth of survey respondents, would seem ideally placed to transition to accountable care organizations. Percentage-wise, this sector has the highest rate of existing ACOs (57 percent participating in ACOs versus 34 percent of overall respondents) and twice the rate of participants in the CMS Pioneer ACO program (25 percent versus 13 percent).

In other deviations from the norm, twice the number of physician group-reported ACOs favor the hybrid FFS + care coordination + shared savings payment model (75 percent of physician-group ACOs versus 37 percent of overall respondents).

More than half of ACOs in this sector are administered by independent physician associations (IPAs), and most are smaller than the hospital-sized ACOs reported in the survey, with three-quarters reporting a physician staff of less than 100. These ACOs benefit from having specialists on board in greater numbers to help with care coordination of the chronically ill (100 percent include specialists, versus 71 percent overall).

They also unanimously include nurse practitioners (versus 90 percent of overall respondents) and with 50 percent including clinical psychologists in the ACO (versus 42 percent overall), are a little further along on the path of integrating behavioral health into the accountable care initiative.

Cognizant of the full care continuum, these IPA-led ACOs are almost twice as likely as overall respondents to include skilled nursing facilities (50 percent versus 29 percent overall) and hospice (75 percent versus 42 percent overall) in their ACOs.

Excerpted from: 2013 Healthcare Benchmarks: Accountable Care Organizations

Infographic: Differences Between ACO Patients and Non-ACO Patients

February 21st, 2014 by Jackie Lyons

The average total cost for a non-accountable care organization (ACO) patient is $470 more than the total cost of care for an ACO patient, according to a new infographic compiled by Health Affairs.

This infographic breaks down the two types of patients by race, Medicaid eligibility, income by geography, participating hospitals and more.

Differences Between ACO Patients and Non-ACO Patients

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Accountable Care Organizations. This 65-page report documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year’s respondents.


Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

3 2014 Trends for Health Plans

January 21st, 2014 by Jessica Fornarotto

Influencing primary care, aggregating and mining data, and embracing bundled or episode-based payments are three trends that will influence health plans in 2014, predicts Catherine Sreckovich, managing director in the healthcare practice at Navigant Consulting.

HIN interviewed Sreckovich on these trends prior to her presentation during HIN’s tenth annual webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: Where will data analytics take health plans in the coming year, and how will this shape population health management offerings?

(Catherine Sreckovich): We’re certainly hearing a lot about big data, and it will be an integral approach to merging this practice’s or population’s health, the ability to aggregate and mine data is going to be an essential capability for health plans for their predictive models. And the outputs of these models are going to enable the health plans to identify and stratify their members or population health. Member and patient demographics can also inform consumer engagement strategies to support population health. And the analytics are going to inform the effectiveness of different care management interventions and consumer engagement strategies.

HIN: Health plan case managers embedded alongside providers has become almost a de facto model. How will payors influence primary care delivery in the year to come?

(Catherine Sreckovich): There is a number of approaches evolving right now and that will continue to evolve as payors attempt to influence primary care delivery. One is the use of patient-centered medical homes (PCMHs) and other integrated models to expand the payor’s role as the primary care case manager.

In addition to paying primary care providers to hire case managers and care coordinators, payors are pushing for shared savings arrangements with these primary care providers, such as within an accountable care organization (ACO), and to push them to manage the care for those with chronic conditions.

We’re also seeing payors paying for primary care physicians to become certified PCMHs and to implement electronic health records (EHRs), either by paying directly for the certification of the technology or by adding bonus payments to their FFS rates.

Payors are also paying for incentives for primary care physicians to offer wellness programs such as smoking cessation or weight loss programs and are trying very hard to influence where and to whom primary care physicians refer their patients by giving them information about the cost and quality of other provider types, such as specialists and hospitals.

And we will continue to see that payors will target the larger primary care physician practices with whom they have a critical mass of members to achieve enough savings to offset the added costs of incentives, bonuses and shared savings arrangements. As a result, we expect that some of the smaller primary care practices will likely not receive the same level of support and push from payors.

In another example, we see payors increasingly partnering with non-traditional providers, such as retail-based clinics and community health centers to offer easily accessible primary care at lower costs. And this will certainly be an opportunity to address some of the physician supply shortages that we anticipate seeing in the next year or so as more and more people have access to healthcare insurance and coverage.

Finally, another approach payors are using is to offer members access to virtual doctor visits via webcam, for example, and other telemedicine approaches that are giving individuals access to these primary care providers to increase access to convenient and low cost primary care for their patients.

HIN: CMS and top-performing Pioneer ACOs are heavily invested in bundled or episode-based payments. Will more private payors embrace this reimbursement method as well?

(Catherine Sreckovich): Definitely. The bundled or episodic-based payment approaches are here to stay. We’re starting to see this take off in a number of states. For example, there are state innovation grants that CMS has provided to states like Arkansas, Ohio, Delaware and others looking for opportunities to implement multi-payor bundled payment initiatives. Although these are not necessarily the traditional ACO model, they built off of that ACO model.

We also see that the large health plans in various states are starting to build and develop ACOs. Key to these are the shared savings arrangements that they’re implementing with these payment approaches. So whether they’re bundled or episodic-based payments or whether they look more like a traditional ACO, if there is such a thing, we’re starting to see takeoffs on those kinds of models as payors and health plans become more creative in the development of their alternatives.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

SNF Community Partnership Shores Up Accountable Care

October 1st, 2013 by Jessica Fornarotto

To support ACO construction, industry thought leaders advise hospitals to monitor what goes on across its care continuum and to partner with facilities it discharges its patients to most often to reduce 30-day readmissions. A prime example is the skilled nursing facility (SNF) network coordinated by Summa Health System, discussed here by Carolyn Holder, manager of transitional care for Summa Health System, and Michael Demagall, administrator of Bath Manor & Windsong Care Center.

(Carolyn Holder) We have been working on a pilot model for accountable care. Accountable care is the focus on primary care wellness in population health. Patients and families need to be actively engaged in this process. It coincides with having the right level of care provided to the patient where they need it, and that is what we are talking about with accountable care. You need partnering relationships between hospitals and physicians and through all levels of care to be able to support that individual in their wellness or illness effectively.

What is the value of this care coordination that worked in the accountable care model of care? It relates to the Triple Aims and looking at providing safe, patient-centered, timely care. We are collaborating to do that with our partner facilities. We have been working at improving health and patient populations in communities. Patients in this situation need rehab, so they have had some functional impairments and frailty. We are trying to get them back to their optimal level of function. To do this, we partner with our SNFs to support that level of care and lower the per capita cost of healthcare.

We also work with community-based long-term care. That has certainly not taken away from any of our nursing facilities any patients that are appropriate or keeping them in the optimal function that they would want.

(Mike Demagall) Through this development of the ACO on the skilled nursing side in working with the hospitals, one thing we focused on was the key indicator comparisons for our 2010 data.

Along with the hospital, we will provide standardized numbers of information that we can get back, that we are going to be held accountable for from the SNF side. The hospital knows what we do is safe and efficient, patient-centered and equitable for everybody involved. As we move forward with the ACO through care coordination, we will look at numbers and information that we can share as a community with the health system so they know what the facilities are doing. There are many reasons that is done, but one of the greatest accomplishments is everybody working together.

Out of 39 homes in the county, the collaboration has been incredible. Initially there was some hesitation, but the collaboration has moved forward, and we are not afraid to share that information. The information is blocked and as we provide information back, it will be blocked from other members except for the hospital, who knows who those numbers are. However, from my facility, I may see a readmission rate at one facility lower than ours although we have the same type of case mix index. I need to look at our facility and ask, “What can we do to get better? What are they doing that we aren’t?” Therefore, everybody gets better as a group, and that is ultimately the goal of the community and the health population in the community we serve.

Healthcare Business Week in Review: Telehealth and Telemedicine, Care Transitions, ACOs

August 23rd, 2013 by Cheryl Miller

Our recently completed study of telehealth and telemedicine identified an uptick in the last three years in videoconferencing for clinical uses like real-time remote diagnostics.

New data from UC Davis Children’s Hospital bears this out: researchers there found that telemedicine consultations with pediatric critical-care physicians significantly improve the quality of care for seriously ill and injured children treated in remote rural EDs. Overall, researchers found that cases involving a telemedicine consultation received significantly higher quality-of-care scores than did those involving a telephone consultation or no consultation.

More ideas to replicate come from a report by the Florida Hospital Association (FHA). At the end of a five-year initiative involving more than 160 Florida hospitals, readmissions dropped 15 percent, surgical complications were reduced by 14.5 percent and millions of dollars in costs were saved.

The hospitals’ hands-on work focused on improvements to hospital culture, care transitions and communication, the FHA said.

A communications gap of sorts has been identified by Athena Health. Its fourth annual Physician Sentiment Index™ (PSI) exposed a general sense of unfamiliarity with the accountable care model among three-quarters of physicians; even more unsettling is the finding that one-quarter of doctors said they “don’t know” if they participate in a pay-for-performance program.

With more than 400 public and private ACOs under construction, a great way to get up to speed on ACO trends is to take our third annual Accountable Care Organizations survey and receive an executive summary of the results.

Deeper Data Dive Improves ACO Performance, Quality

August 1st, 2013 by Jessica Fornarotto

Performance Quality Measurement and Reporting for Accountable Care webinar replay

What started as a closer look at John C. Lincoln Network’s 30-day Medicare readmissions for heart attack, heart failure and pneumonia kicked off a plethora of quality improvements for the Medicare Shared Savings Program, including the hiring of care transition coaches, extension of primary care hours and tightening of key gaps in care.

During HIN’s webinar, Performance Quality Measurement and Reporting for Accountable Care, two experts from JCL shared how their organization modified reporting processes — from workflow changes to customizations within its EMR — to improve performance results during its 2013 reporting year.

For its transition coach program, developed to reduce Medicare 30-day readmissions, JCL hired trained military medics to help recently discharged patients transition more easily from one setting to another, explained Heather Jelonek, chief operating officer for ACOs at JCL.

“These transition coaches go into the hospitals and meet with patients when they are admitted. They get to know the patients, they develop a rapport, and they also start to prepare the patients for discharge.”

After discharge, these coaches follow the patient for a minimum of 30 days to follow up on medical care, monitor blood pressure, explain medications and teach the patient about nutrition with the help of a registered dietician.

A deeper data dive also identified a trend among its Meals on Wheels beneficiaries: 85 percent of these patients were readmitted within 30 days almost always on Friday evenings. The patients did not have enough food to get them through the weekend since Meals on Wheels only delivers during the week.

This program has helped to reduce readmission readmission rates from almost 20 percent to just under 2 percent for those patients receiving Meals on Wheels and became an assessment area for the transitions coaches.

Encouraged, JCL sought to learn what additional data they needed from their system to respond to the reporting requirements for CMS’s 33 quality measures. They determined their course of action for 2012 and the building requirements for 2013. According to Karen Furbush, business consultant for JCL, “we have to continually re-educate each of the practices at the hospital and the ED so that they can continue to remember what’s important. And it’s not just for the ACO measures, but in general for better coordinated care.”

One change implemented immediately was the addition of a new message within EPIC, an ADT inbasket message that alerts the primary care physician (PCP) to schedule a follow-up visit within seven days. The PCP then reviews the message and forwards it to the medical assistant (MA) to schedule the visit. This change helped to meet one of the ACO quality measure as well as the transitional care management incentive.

Realizing that enhancements were needed for quality reporting, JCL added additional logic to its patient health questionnaire for future fall risk, aspirin usage and a depression scale. JCL also has ACO patient navigators who analyze reports to determine which patients were missing required measurement values and then schedule those patients by the end of the year as needed, noted Ms. Furbush. “We learned how to get the information out and quickly assess who hasn’t had the influenza or pneumococcal shots, or […] a mammography or a colorectal screening. We wanted to go out and capture that information as quickly as possible because we still had three months left to be able to find that information, whether it was in a previous system or if it was in our current EMR,” explains Furbush.

“We immediately tried to get on the phone to start scheduling these appointments, working through all the things that we need to do for the ACO, as well as just bringing the patient into the EMR completely,” Furbush continued.

Furbush also started a weekly ACO quality reporting call to discuss a group of measures to see what kind of challenges were being faced and what was being implemented. JCL also hosted two EPIC-specific subset calls to learn how everyone was using EPIC.

Once JCL received its patient sample from CMS, it sent samples to each practice. According to Furbush, “We said [to the practices] this is what CMS said this person happens to be associated with. There are 15 categories and CMS will provide a rank of one to 616, one being the highest. You have to report on 411. We had to let them know where the patients ranked for each of the disease states and that we needed information back from them if we couldn’t get it from the EMR.”

JCL continues to struggle with integration opportunities. According to Jelonek, “This includes talking to other communities and looking at HIEs as we’re making an acquisition of a new practice or signing a new community physician onto the ACO. In other words, bringing everybody to the table so that we’re all speaking the same language.”