Transcript ACO
Improving Quality Through the Accountable Care Organization (ACO) Cheryl Jansen RN BSN Candace L. McGovern RN Clinical Application Analyst II University Hospitals Manager, IT Clinical Applications Susan Semrau RN, CPHQ Elizabeth R. Hammack Associate General Counsel University Hospitals Health System, Inc. Senior Quality Improvement Nurse Institute for Healthcare Quality & Innovation William W. Steiner II, MD PhD Interim President, University Hospitals ACO Nathan Hunt Director, University Hospitals Accountable Care Organization Corinne Hurley Director Clinical Management UHPS Michele Lemonovich RN Clinical Liaison, UHCare University Hospital Geauga Medical Center Eric M. Yasinow, M.D. Medical Director, UHACO Objectives • Provide introduction to ACO • Present ACO quality measures • Understand how using the AEMR can improve quality • Be aware of shared Savings and Financial Incentives for Physicians 4/9/2015 University Hospitals 2 UH Accountable Care Organization Strategy & Initiatives 4/9/2015 University Hospitals 3 Total Expenditures and % Gross Domestic Product (GDP) $5,000 $4,500 National Health Expenditures 25% % of GDP $4,000 20% 17.2% $3,500 Trillions $3,000 15% 2.8T $2,500 $2,000 10% $1,500 $1,000 5% $500 $0 0% 1960 1970 1980 1990 1993 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2020 Projected 4/9/2015 University Hospitals 4 Volume 348(26) 26 June 2003 pp 2635-2645 The Quality of Health Care Delivered To Adults In the United States McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer: DeCristofaro, Alison: Kerr, Eve A. BACKGROUND We have little systematic information about the extent to which standard processes involved in healthcare—a key element of quality—are delivered in the United States. METHODS We telephoned a random sample of adults living in 12 metropolitan areas in the United States and…received written consent to copy their medical records…to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventative care… RESULTS Participants received 54.9 percent of recommended care. CONCLUSIONS The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits are warranted. 4/9/2015 University Hospitals 4 UHACO Strategy • Achieve improved outcomes for patients of all ages: – Quality of care, – Patient experience, and – Cost of care • Maximize value of high quality patient-centered care • Remain ahead of the ‘health reform curve’ • Pilot new models of care delivery and reimbursement • Leverage expanded system to coordinate care: – Large primary care network – Outpatient facilities – Technology 4/9/2015 University Hospitals 6 UH ACO Objectives & Strategies Objective Strategies Improve Population Health • Increase preventive care and wellness activities • Expand clinical care protocols built around UH Centers of Excellence Enhance Patient Experience of Care • Coordinate care across health system • Increase role of Primary Care Physician (PCP) • Engage patients and families Reduce And Control Cost of Care • Deliver care in appropriate settings by appropriate providers • Minimize waste & duplication 4/9/2015 University Hospitals 7 UHACO Initiatives University Hospitals Rainbow Care Connection Pediatric ACO ACO: University Hospitals Accountable Care Organization Employee/ Commercial ACO Payer: Medicare ACO Centers For Medicare & Medicaid Services (CMS) Center for Medicare & Medicaid Innovation (CMMI) Attributed Membership: University Hospitals Coordinated Care Organization 70,000 80,000 50,000 Ohio Medicaid Self-Insured Plans/ Commercial Payers Medicare Traditional Attributed lives account for over $1 Billion in annual medical expenditures 4/9/2015 University Hospitals 8 UH Accountable Care Organization Quality 4/9/2015 University Hospitals 9 Medicare ACO Quality Reporting • Quality reporting of 33 measures in 4 domains required for shared savings – Patient/Caregiver Experience – Care Coordination/Patient Safety – Preventative Health – At-Risk Populations • Replaced PQRS Reporting for Physician Incentive – Achieved for all UH Physicians 2012 & 2013 • 2014 Reporting begins January 26, 2015 • Select results published on Physician Compare 4/9/2015 University Hospitals 10 4/9/2015 University Hospitals 2012 **Confidential** ACO #32 – 33 ACO #31 ACO #30 ACO #29 ACO #28 ACO #27 ACO #22 – 26 ACO #21 ACO #20 ACO #19 ACO #18 ACO #17 ACO #16 ACO #15 ACO #14 ACO #13 ACO #12 ACO #11 ACO #10 ACO #9 ACO #8 ACO #7 ACO #6 ACO #5 ACO #4 ACO #3 ACO #2 ACO #1 Percentiles 2012 & 2013 Quality Results: 2014 Percentiles 90 80 70 60 50 40 30 20 10 0 2013 11 2012 & 2013 Quality Results: 2014 Percentiles Patient/Caregiver Experience Measure 4/9/2015 University Hospitals 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 **Confidential** 12 2012 & 2013 Quality Results: 2014 Percentiles Care Coordination/Patient Safety Measure 4/9/2015 University Hospitals 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 **Confidential** 13 2012 & 2013 Quality Results: 2014 Percentiles Preventive Health Measure 4/9/2015 University Hospitals 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 **Confidential** 14 2012 & 2013 Quality Results: 2014 Percentiles Diabetes Composite Measure 4/9/2015 University Hospitals Description ACO #22 Hemoglobin A1c Control (<8%) ACO #23 Low Density Lipoprotein (<100mg/dL) ACO #24 Blood Pressure <140/90 ACO #25 Tobacco Non Use ACO #26 Aspirin Use **Confidential** 15 2012 & 2013 Quality Results: 2014 Percentiles At-Risk Populations Measure 4/9/2015 University Hospitals Description ACO #27 % of beneficiaries with diabetes whose HbA1c in poor control (>9%) ACO #28 % of beneficiaries with hypertension whose BP <140/90 ACO #29 % of beneficiaries with IVD with complete lipid profile and LDL control <100mg/dl ACO #30 % of beneficiaries with IVD who use Aspirin or other antithrombotic ACO #31 Beta-Blocker Therapy for LVSD **Confidential** 16 2012 & 2013 Quality Results: 2014 Percentiles Coronary Artery Disease (CAD) Composite Measure 4/9/2015 Description ACO #32 Drug Therapy for Lowering LDL Cholesterol (Removed From Program) ACO #33 ACE Inhibitor or ARB therapy for patients with CAD and Diabetes and/or LVSD University Hospitals **Confidential** 17 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 4/9/2015 University Hospitals Status NEW 18 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 4/9/2015 % of patients 18-75 with Type 1 & 2 Diabetes with retinal/dilated eye exam in measurement period or negative in the year prior University Hospitals NEW 19 UHACO Commercial Programs • Shared savings targets based on lower cost of care and quality targets met – Quality measured for preventative, disease-specific, & hospital care – Quality alignment across programs where possible • UHACO to provide population health services to improve quality and help manage cost • Provider network includes University Hospitals employed providers – Fee for service reimbursement to providers with potential for shared savings 4/9/2015 University Hospitals 20 UHACO Commercial Programs Quality Measures Medicare ACO Commercial ACO Programs Colorectal Cancer Screening Breast Cancer Screening Cervical Cancer Screening Chlamydia Screening Pediatric Measures Diabetic preventive screenings Diabetic HbA1c controlled Heart Failure/CAD Hospital Re-Admissions Hospital Length of Stay Pregnancy Management 4/9/2015 University Hospitals 21 UH Accountable Care Organization Infrastructure & Support 4/9/2015 University Hospitals 22 UHACO Population Health Management Centralized and practice-based team focused on coordinating care for ACO populations: – – – – – – – Patient Navigators (Central & Embedded) Nurse Care Coordinator Health Educators & Dietitians Social Worker Pharmacist Network Administrator Data Analyst Analyze Population Identify 4/9/2015 Engage Connect University Hospitals 23 University Hospitals 23 UHACO Population Health Management Health Education & Wellness Programs for broad population needs All Members Preventative Care Adherence Align primary care physicians & protocols Screening Campaigns Resolve gaps in care Disease Management Address chronic illnesses Targeted Outreach Case Management Individualized care Highest Risk © 2013 University Hospitals Health System, Inc. All rights reserved. 4/9/201501/15/201 3 24 UHACO Population Health Management • Health Education & Wellness: Programs for broad population needs • Preventative Care Adherence: Align primary care physicians & protocols UHACO Physician & Provider Update 4/9/2015 University Hospitals 25 Leveraging Resources & Technology • Utilizing Electronic Medical Record (EMR) for ACOspecific functions – Tasking – Health maintenance log – Quality documentation • Expanding ability to schedule directly 4/9/2015 University Hospitals 26 Colonoscopy Campaign: Initial Telephonic Outreach • 1,040 commercial ACO members • 1,632 call attempts 4/9/2015 University Hospitals 27 Colonoscopy Campaign: Fecal Immunochemical Testing (FIT) 4/9/2015 University Hospitals 28 UHACO Mammogram Campaign Compile ACO member/beneficiary data emmi scheduling outreach & warm transfers to 216-844-BRST UHACO Patient Navigator in-office outreach UHACO Network Administrator to organize physician orders for mammograms Outreach to ACO members/beneficiaries to schedule UHACO follow up with ordering physicians on documentation Coordinate with UH #WomanUp Marketing Campaign 4/9/2015 University Hospitals 29 UHACO Master Patient Index ACO Population Indicator 4/9/2015 University Hospitals 30 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 4/9/2015 University Hospitals 31 UHACO Transitions of Care 4/9/2015 University Hospitals 32 Discussion • • • 11/22/14 University Hospitals 33 2/08/2010 4/9/2015 University Hospitals 34