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
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UH Accountable Care Organization
Strategy & Initiatives
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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
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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.
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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
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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
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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
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UH Accountable Care Organization
Quality
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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
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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
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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
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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
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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
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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
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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
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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
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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
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% 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
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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
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UH Accountable Care Organization
Infrastructure & Support
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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
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Engage
Connect
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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.
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UHACO Population Health Management
• Health Education & Wellness: Programs for broad
population needs
• Preventative Care Adherence: Align primary care
physicians & protocols
UHACO Physician & Provider Update
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Leveraging Resources & Technology
• Utilizing Electronic Medical Record (EMR) for ACOspecific functions
– Tasking
– Health maintenance log
– Quality documentation
• Expanding ability to schedule directly
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Colonoscopy Campaign:
Initial Telephonic Outreach
• 1,040 commercial ACO members
• 1,632 call attempts
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Colonoscopy Campaign: Fecal
Immunochemical Testing (FIT)
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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
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UHACO Master Patient Index
ACO Population
Indicator
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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 Transitions of Care
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Discussion
•
•
•
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2/08/2010
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