Download ACO - Department of Medicine, Case Western Reserve University

University Hospitals Accountable Care
Organization (UHACO)
Department of Medicine Clinical Retreat
Eric M. Yasinow, M.D.
Medical Director, University Hospitals Accountable Care Organization
UHACO Initiatives
ACO:
University Hospitals
Rainbow Care Connection
University Hospitals
Accountable Care
Organization
Pediatric Medicaid
ACO
Commercial
ACO
Center for Medicare
& Medicaid
Innovation (CMMI)
Attributed
Membership:
Payer(s):
University Hospitals
Coordinated Care
Organization
Medicare
ACO
Centers For Medicare
& Medicaid Services
(CMS)
70,000
181,500
50,000
Ohio Medicaid
Self-Insured Plans/
Commercial Payers
Medicare Traditional
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UHACO Programs
• Fee for service reimbursement to providers with
potential for shared savings
•
Shared savings targets based on lower cost of care
and quality targets met
– Quality measured for preventative, disease-specific, &
hospital care
• All programs, except UH Employee Medical Plan,
have open and/or non-tiered provider network
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UHACO Programs Summary
•
Government ACO Programs:
– Medicare Shared Savings Program ACO – Traditional Medicare
Members
– Center For Medicare & Medicaid Services – Medicaid Pediatric
Members
•
Commercial Payor ACO Programs:
– Aetna: Commercial & Medical Advantage
– Anthem: Commercial & Medical Advantage
– Cigna Commercial
– Humana Medicare Advantage
– United Healthcare: Commercial & Medical Advantage
•
Self-Insured Employers ACO Programs:
– University Hospitals Employee Medical Plan
– St. Johns Medical Center Employee Medical Plan
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UHACO Population Health & Wellness
CONFIDENTIAL © 2015 University Hospitals Health System, Inc. All rights reserved.
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UHACO Technology Infrastructure
• Master Patient Index identifying patients across UH:
• Electronic Medical Record: Inpatient, Ambulatory, Emergency
Department
• Inpatient Registration & Billing (Soarian)
• Physician Practice Registration & Billing (Athena)
• Data analytics:
•
•
•
•
•
•
Population health needs assessment
Proactively identify patients for UHACO team outreach
Patient engagement
Network quality performance
Clinical integration
Provide providers with external view of patient acuity and needs
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UHACO Master Patient Index
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UHACO Team Outreach
•
Patient Navigators
– Gaps in Care
– Post-primary care visit follow up
•
Nurse Care Coordinators
– Complex Case Management
– High Utilizer & Transitions of Care
•
Pharmacist
– Medication management issues
– Targeted questions to assess intervention needs
•
Social Worker
– Independence at home assessment
– Barriers to care assessment
•
Health Educators
– Goals for nutrition education and tobacco cessation
CONFIDENTIAL © 2013 University Hospitals Health System, Inc. All rights reserved.
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UHACO Patient Engagement Technologies
Central point for
patient messaging and
tracking
- Analytics to identify
engagement
opportunities
- Provider population
health tool
- Customized
assessments & patient
goals to guide outreach
- Patient education
modules
- Population health
campaigns
- Patient self-monitoring
& data collection
Remote monitoring
technology for
specific conditions
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UHACO Quality Measures
•
•
•
•
•
•
•
•
•
•
•
•
Immunizations
Screenings: Cancer
Screenings: Preventive
Depression
Diabetes
Hypertension
Ischemic Vascular Disease
Coronary Artery Disease
Asthma
Bone Density
Illness Treatment
Hospital Measures
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UHACO Transitions of Care
• During Hospitalization:
– Visit selected beneficiaries
• Post-Hospitalization:
– Contact beneficiary within 72 hours of discharge
• Confirm Primary Care Provider (PCP)
appointment
• Review medications & discharge notes
• Document needs assessment
– Conduct follow up coordination as indicated
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UHACO Emergency Department (ED) Activities
•
UHACO Outreach:
– Within 72 hours of ED visit for ACO members as appropriate
• Ensure follow up services scheduled where indicated
• Education provided for avoidable visits
– Case management for frequent ED utilizers
•
Technology & Workflow:
– Utilizing EMR to notify PCP of ED visit
– Identifying ACO members on ED Bed Board
– Working with ED leadership on coordinating next day
appointments with PCP if admission avoidable
•
Analytics:
– Analyzing frequent ED utilizers by zip code to evaluate access
– Evaluating trends by employer group
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UHACO Medical Directors
•
Review Clinical Referrals:
– All readmissions
– Beneficiaries in case management
– Beneficiaries requiring a new specialist relationship without a
specific referral
– Providers with patterns of gaps in care
•
Educate UHACO Network
– Provide provider-specific data on
• Patients
• Performance
• Metrics
– Provide context of ACO efforts & health care reform
CONFIDENTIAL © 2013 University Hospitals Health System, Inc. All rights reserved.
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UH Coordinated Care Organization (“UHCCO”)
2014 Medicare ACO Quality Measures & Results
Medicare Quality Reporting
•
Quality performance scores are shown as percentiles
based on performance standards set by CMS
•
Each percentile is worth a correlated number of points
– In order to receive any points for a measure, a Medicare
ACO must score over the 30th percentile
•
The ACO Quality Score is based on the percentage score
in each domain
•
The ACO Quality Score determines the amount of shared
savings the Medicare ACO is eligible to share
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2014 Quality Results: Overall Domain Scores
Domain
Points
Earned
Points
Possible
CMS
Target %
UHCCO
Actual %
Patient / Caregiver
Experience
9.70
14
70%
69.29%
Care Coordination /
Patient Safety
11.30
14
70%
80.71%
Preventive Health
13.60
16
70%
85.00%
At Risk Population
12.95
14
70%
92.50%
ACO Quality Score
81.88%
2012 & 2013 required only reporting of individual measures,
resulting in an overall score of 100%
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2012, 2013, 2014 Quality Results:
Patient/Caregiver Experience
Percentile
Measure
Description
ACO #1
Getting Timely Care,
Appointments, and Information
ACO #2
How Well Your Doctors
Communicate
ACO #3
Patients’ Rating of Doctor
ACO #4
Access to Specialists
ACO #5
Health Promotion and Education
ACO #6
Shared Decision Making
ACO #7
Health Status/Functional Status
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2012, 2013, 2014 Quality Results:
Care Coordination/Patient Safety
Percentile
Measure
Description
ACO #8
Risk Standardized, All Condition
Readmissions
ACO #9
ASC Admissions: COPD or Asthma
in Older Adults
ACO #10
ASC Admission: Heart Failure
ACO #11
% of PCPs Qualified for EHR
Incentive Payment
ACO #12
Medication Reconciliation
ACO #13
Falls: Screening for Fall Risk
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2012, 2013, 2014 Quality Results:
Percentile
Preventive Health
Measure
Description
ACO #14
Influenza Immunization
ACO #15
Pneumococcal Immunization
ACO #16
Adult Weight Screening and
Follow Up
ACO #17
Tobacco Use Assessment and
Cessation Intervention
ACO #18
Depression Screening
ACO #19
Colorectal Cancer Screening
ACO #20
Mammography Screening
ACO #21
Proportion of Adults who had
blood pressure screening in last 2
years
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2012, 2013, 2014 Quality Results:
Diabetes Composite
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2012, 2013, 2014 Quality Results:
At-Risk Populations
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2012, 2013, 2014 Quality Results:
At-Risk Populations: CAD Composite
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2015 Medicare ACO Quality Measures
Measure
Description
ACO #34
CAHPS
Stewardship of Patient Resources
NEW
ACO #35
Skilled Nursing Facility 30-Day All Cause Readmission
Measure
NEW
ACO #36
All-Cause Unplanned Admissions for Patients with
Diabetes
NEW
ACO #37
All-Cause Unplanned Admissions for Patients with Heart
Failure
NEW
ACO #38
All-Cause Unplanned Admissions for Patients with
Multiple Chronic Conditions
NEW
ACO #39
Documentation of Current Medications in Medical
Record
NEW
ACO #40 Depression Remission at Twelve Months
Status
NEW
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2015 Medicare ACO Quality Measures
Measure
Description
Status
ACO #22 Diabetes Composite: Hemoglobin A1c Control (<8%)
REMOVED
ACO #23 Diabetes Composite: LDL (<100mg/dL)
REMOVED
ACO #24 Diabetes Composite: Blood Pressure <140/90
REMOVED
ACO #25 Diabetes Composite: Tobacco Non Use
REMOVED
ACO #26 Diabetes Composite: Aspirin Use
REMOVED
ACO #27
% of beneficiaries with diabetes whose HbA1c in poor
control (>9%)
RESCORED
Diabetes: Eye Exam
ACO #41
% of patients 18-75 with Type 1 & 2 Diabetes with retinal/dilated eye exam
in measurement period or negative in the year prior
NEW
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UHACO Provider Engagement
•
Utilize University Hospitals facilities and providers
•
Increase access
•
Ask patients
• if they understood the information you provided &
• if you answered all their questions during visit
•
Get Help With Your High Utilizers
•
Use Electronic Medical Record for UHCCO Patient
Navigator Quality Measures
•
Appropriately and completely capture services &
diagnoses
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UHACO Contact
If you would like more information about our ACO initiatives or would
like to request care coordination services for your patients, please
contact us at [email protected]
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2/08/2010
5/8/2017
University Hospitals
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