Transcript Accountable Care Organization Presentation

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:
•
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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
•
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•
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•
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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
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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
3/29/2016
University Hospitals
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