Transcript Risk Contracting & Pioneer ACO 101

ACO 101:
Overview of Dartmouth-Hitchcock
Health Pioneer ACO Model and
OneCare Vermont ACO Models
Lynn Guillette, CPA, MBA
May 3, 2014
The Health Care Ecosystem in 2014
The U.S. ranks last or next to
last in five key areas¹:
Structural Challenges
 Quality
 Fragmented delivery system with
lack of primary care
 Access
 Lack of evidence based care often
drives variation in quality &
patient safety
 Efficiency
 Misalignment of incentives
 Equity
 Transaction-based payment
system
 Healthy Lives
 Lack of transparency
 Limited focus on quality
2
¹The Commonwealth Fund – June 2010
How Can Dartmouth-Hitchcock Health Address
These Challenges?
Transform
Payment System
from
TransactionBased to
Outcomes-Based
Transform
Delivery System
to PatientCentered Care
System
Change
the
Structure
3
Who is Dartmouth-Hitchcock Health?
IvyMD
OneCare
Vermont ACO,
LLC
(50% owner)
Dartmouth-Hitchcock
Health
New London
Health
Association
D-H
DartmouthHitchcock Clinic
Mary Hitchcock
Memorial
Hospital
New England
Alliance for
Health
4
D-HH’s Work is Focused Into 7 Strategic Domains
Under 3 Enterprise Core Strategies
Create A Sustainable Health System
Mission, Vision, Values
Performance
Imperatives >
D-H Enterprise
Core Strategies >
The strategic
domains provide
additional focus for
the D-H enterprise
core strategies
Improve Quality Outcomes
Population Health
Improve
Population
Health
Reduce Cost of Care
Value-Based Care
Integrated
Health
System
Distinctive
Education
& Research
People
New Payment Models
Leaders
in
Value
Innovation
Finance
5
Creating A Sustainable Health
System
Population
Health
NEAH
Boston Children’s
So. NH & Seacoast
Value Based Care
HVHC
Mayo
NNEACC
Dartmouth College
Industry Partners
New Payment
Models
Pioneer•
OneCare VT
Health Plan
Partner
ME
NH
VT
•
•
DHMC
•
D-H Keene
D-H Putnam
•
D-H Concord
• •
D-H Manchester
•
D-H Nashua
MA
-Confidential-
6
End-State Goals – Where Are We Heading?
The D-H Strategic Operating Plan Matrix helps us to focus on a single year at a time. The 2015
plan will be designed to expand more on our medium to long-term strategic objectives, including:
• Provide care and wellness services to 2+ million people
Fully
Integrated
• Measurably improve population health
• Implement value-based care processes across D-H
Care Model
• Participate to the fullest extent possible in payment models
that recognize the value of care delivered
• Develop an integrated NNE healthcare network
• Refine and expand an integrated NNE support and
management services infrastructure
Payment Model
Fee for
Service
Global
Capitation
• Enable more care and wellness to be delivered at community
level and at home
• Align D-H workforce with enterprise strategies/objectives
• Align research and education to support achievement of a
sustainable health system
Fragmented
Delivery
• Establish innovative partnerships with government and
industry that improve care and wellness
• D-H recognized as a national leader in creating value and
implementing a sustainable health system
7
To Transform the Payment
System, We Need to Learn a New
Language
Fee For
Service
Global Budget
Accountable
Care
Organization
Pay for
Performance
Shared Risk
8
Payment Model Continuum
Fee-For Service - is a payment model where services are unbundled and paid for separately by service
Pay-For-Performance - introduces quality and efficiency incentives, instead of solely rewarding quantity
Shared Risk - means distributing the cost of health care services across large numbers of participants including people of various ages and health conditions
Global Budget / Capitation - is a payment arrangement for health care services that pays a physician or
group of physicians a set amount for each enrolled person assigned to them, per period of time, whether or
not that person seeks care
Fee-ForService
Volume
Focused
Pay-forPerformance
Shared
Risk
Capitation
Global
Budget
Value
Focused
Accountable Care Organization (“ACO”) - is a healthcare organization characterized by a payment and care
delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of
care for an assigned population of patients
9
More about ACOs
 Providers in an ACO may all belong
to the same health system, or may
include multiple health systems,
independent hospitals, physician
groups/practices, and other types of
healthcare providers
Providers work together with a
payor to provide high quality
coordinated care for patients
Doctors,
Hospitals,
Other
Healthcare
Providers
May include one or more payors
May include any one (or more) of
the four payment methodologies
outlined on slide 9
Quality performance is measured at
the aggregate ACO level
Accountable
Care
Organization
(“ACO”)
Payor(s)
The ACO would be rewarded for
providing the ACO’s patients with a
positive patient experience, better
health outcomes, and reduction in the
growth of total cost of care for the ACO
patient population
10
What Does D-H’s Payments Models
Look Like Today?
11
Transformation to date at D-H
(Directly Managing or Influencing 182,000+ lives)
DartmouthHitchcock Wellness
Plus
(Administered by
Health Plans Inc.)
D-H Employee
Health Benefit
Plan(s)
16,000 lives
Medicare ACOs
D-HH AllWell
ACO
Pioneer Model
Started 1.1.12
46,000 lives
OneCare
Vermont ACO
Shared Savings
Program
Started 1.1.13
45,000 lives
Medicaid ACOs
OneCare
Vermont ACO
Shared Savings
Program
Started 1.1.14
# lives TBD
Commercial
Exchange ACOs
OneCare
Vermont ACO
Shared Risk
Program with
BCBS of VT &
MVP
Started 1.1.14
# lives TBD
Commercial Shared
Savings/Risk
Contracts
D-H/Anthem
BCBS of NH
Started 10.1.10
47,000 lives
D-H/Cigna
Started 6.1.08
20,000 lives
D-H/Harvard
Pilgrim Health
Care
Started 1.1.11
8,000 lives
12
CMS Pioneer ACO Model
• CMS Pioneer ACO Model: Medicare shared risk program that
incorporates the ACO concept; ACO has financial risk if actual
costs exceed annual cost target but has financial reward
opportunity if actual costs are less than annual cost target
• Through competitive application process, D-HH became one of
thirty-two Pioneer ACOs in the country
D-HH ACO
17,536
attributed
beneficiaries
Mary Hitchcock
Memorial
Hospital
DartmouthHitchcock Clinic
13
Pioneer ACO Model Attributed Population Requirements
Pioneer ACO
Nurse Practitioners
& Physician
Assistants:
E & M codes billed
under the name of a
primary care Nurse
Practitioner and
primary care
Physician Assistant
“count” for attribution
purposes
TIN Commitment:
Once the TIN is
committed to a
Medicare ACO, that
TIN is then limited to
be a vendor/supplier
to other Medicare
ACOs.
15,000 minimum attributed
Medicare beneficiaries across
entire ACO
Attribution refreshed annually
Two-stage attribution algorithm
based on preponderance of qualifying
E & M codes provided by primary
care and 8 other specialty types
Primary Care defined as: MDs, DOs,
NPs, and PAs practicing in General
Practice, Family Practice, Internal
Medicine, Geriatric Medicine
Algorithm:
Uses a two-stage
algorithm for attribution
New providers during
performance year:
Under Pioneer, the
annual TIN/NPI roster
may only be revised to
reflect providers leaving
the ACO during the year.
New hires may only be
added at time of the
annual TIN/NPI roster
submission.
8 Specialty Types for
2nd stage of attribution:
Nephrology
Oncology
Rheumatology
Endocrinology
Pulmonology
Neurology
Neuropsychiatry
Cardiology
14
The Triple Aim
Better Care for
Individuals
Lower per
Capita Costs
Better Health
for a Population
15
Pioneer ACO Model – Quality Comes First in Achieving the Triple Aim
4 Domains; 33 Individual Measures; 48 Possible Points in 2013
• 7 measures
• Possible Points per
Domain = 4
• Domain Weight =
25%
• 8 measures
• Possible Points per
Domain = 16
• Domain Weight =
25%
• 6 measures
• Possible Points per
Domain = 14
• Domain Weight =
25%
Patient/
Caregiver
Experience
Care
Coordination/
Patient Safety
Preventative
Health
At-Risk
Population
Health
Management
• 12 measures
• Possible Points per
Domain = 14
• Domain Weight =
25%
16
D-HH Pioneer ACO Financial Model –
For Illustrative Purposes Only
Cost Target
Expected cost per beneficiary per year
times number of attributed beneficiaries
$10,000 * 30,000 = $300,000,000
Actual Cost Expenditures
Actual cost per beneficiary per year
times number of attributed beneficiaries
$9,800 * 30,000 = $294,000,000
Gross Savings
Cost Target less Actual Cost Expenditures
$300,000,000 -$294,000,000 =
$6,000,000
Minimum Savings Rate (MSR)
Threshold
Cost Target times 1%
$300,000,000 * 1% = $3,000,000
If Gross Savings or Gross
Loss is 0% to 1%, CMS
keeps total savings or
absorbs total loss
Gross Savings Rate
Gross Savings divided by Cost
Target
$6,000,000/$300,000,000 = 2%
If Gross
Savings
Rate >
MSR
ACO Shared Savings
Gross Savings times 70%
$6,000,000 * 70%= $4,200,000
Quality
Multiplier
Applied
(0.00100.00)
Gradient
quality scores
impact eligible
shared savings
17
D-HH Pioneer ACO in 2013
• For year two, expanded ACO
participation by adding one Critical
Access Hospital and its employed
physicians
• Criteria for adding NLHA:
• D-H & NHLA affiliation discussions
were underway; ACO inclusion
would foster continued clinical
integration
• NLHA’s Chief Medical Officer was a
former D-H physician who had
championed accountable care,
shared-decision making, evidencebased medicine, and shared the
same care coordination philosophy
• NLHA’s patients generally used D-H
for specialty care
D-HH ACO
Mary Hitchcock
Memorial
Hospital
DartmouthHitchcock
Clinic
New London
Hospital
Association
25,413
attributed
beneficiaries
18
D-HH Pioneer Expansion in Year 3
• D-H determined that it needed to expand Pioneer ACO
participants beyond D-H and NLHA
• Why?
• To move closer to achieving our vision of creating a sustainable
health system with the healthiest population possible
• To lead the transformation of health care in our region and to
set the standard for the nation
• How?
• Create rigor and structure to the expansion identification,
selection, and implementation process
• Adequately assess business risk to D-H and its ACO because of
changes in composition of ACO provider participation
19
D-HH Pioneer ACO in 2014
46,700
attributed
beneficiaries
D-HH ACO
Mary
Hitchcock
Memorial
Hospital
DartmouthHitchcock
Clinic
Clinical Advisory Council
New London
Hospital
Association
Catholic
Medical Center
Leadership Council
Exeter Health
Resources/
Core
Physicians
St. Joseph
Hospital
Performance Reporting
20
•
Medicare Shared Savings Program (“MSSP”)
Model
Medicare Shared Savings Program Model: Medicare shared savings program that incorporates the
ACO concept; initial 3-year contract; ACO has no financial risk in any of the first 3 years if actual costs
exceed annual cost target but has financial reward opportunity if actual costs are less than annual
cost target in any of the first 3 years
•
OneCare Vermont ACO, LLC was jointly formed by Fletcher Allen Health Care and DartmouthHitchcock Health in summer of 2012
•
Through application process, OneCare Vermont ACO became one of 218 MSSP ACOs in the country (#
of ACOs has since grown to 341)
•
Others in VT or NH:
•
•
•
•
Accountable Care Coalition of Green Mountains, LLC (Independent physician practice model in VT)
Community Health Accountable Care, LLC (FQHC-led model in VT and NH)
Concord Elliot ACO, LLC (Hospital system-led model in NH)
North Country ACO (FQHC-led advanced payment model in NH)
Fletcher Allen
Health Care
DartmouthHitchcock
Health
21
MSSP Model Attributed Population Requirements
Nurse Practitioners
& Physician
Assistants:
E & M codes billed
under the name of a
primary care Nurse
Practitioner and
primary care
Physician Assistant
DO NOT “count” for
attribution purposes
TIN Commitment:
Once the TIN is
committed to a
Medicare ACO, that
TIN is then limited to
be a vendor/supplier
to other Medicare
ACOs.
MSSP
5,000 minimum attributed
Medicare beneficiaries across
entire ACO
Attribution refreshed quarterly
Algorithm:
Uses a two-stage
algorithm for attribution
but not the same one
used for the Pioneer
model
Two-stage attribution algorithm
based on preponderance of qualifying
E & M codes provided by primary
care and all other specialty types
Primary Care defined as: MDs, and
DOs, practicing in General Practice,
Family Practice, Internal Medicine,
Geriatric Medicine
22
MSSP ACO Model – Quality Comes First in Achieving the Triple Aim
4 Domains; 33 Individual Measures; 48 Possible Points in 2013
• 7 measures
• Possible Points per
Domain = 4
• Domain Weight =
25%
• 8 measures
• Possible Points per
Domain = 16
• Domain Weight =
25%
• 6 measures
• Possible Points per
Domain = 14
• Domain Weight =
25%
Patient/
Caregiver
Experience
Care
Coordination/
Patient Safety
Preventative
Health
At-Risk
Population
Health
Management
• 12 measures
• Possible Points per
Domain = 14
• Domain Weight =
25%
23
Organizational Structure
OCVT Board of
Managers
Composition (16 seat
board):
 D-HH = 3 seats
 FAHC = 3 seats
 Gifford Medical Ctr = 1
seat
 Private/community
practice physician = 1
seat
 Medicare beneficiary = 1
seat
 CHS of Lamoille Valley =
1 seat
 Southwestern VT
Medical Ctr = 1 seat
 Primary Care Health
Partners = 1 seat
 The Howard Center = 1
seat
 The Pines at Rutland = 1
seat
 Medicaid beneficiary = 1
seat (vacant)
 Commercial Exchange
consumer = 1 seat
(vacant)
OneCare Vermont
ACO Board of
Managers
Chief Medical
Officer
Chief Executive
Officer
Clinical Advisory
Board
Chief Compliance
Officer
Chief Operating
Officer
Administrative
Directors/Staff
Executive Medical
Director
Care Management
& Quality
Directors/Staff
24
OneCare Vermont 2014 MSSP Network
Statewide ACO Provider
Network
• 2 Academic Medical Centers
• 14 Community Hospitals
• 1 Behavioral Health/Substance
Abuse Facility
• 2 Federally Qualified Health
Centers
• 5 Rural Health Clinics
• 58 Private Practices
• 280 Primary Care Physicians
across Network Participants
• Approximately 42,000 attributed
Medicare beneficiaries
Hospitals with Employed Attributing Physicians
Significant Participation from Community Physicians
OneCare Vermont ACO MSSP Model
26
NNEACC
• NNEACC: Northern New England Accountable Care
Collaborative
• Data Trust owned by Dartmouth College, DartmouthHitchcock, Eastern Maine Health, Fletcher Allen Health
Care, and MaineHealth
• Used by both D-HH Pioneer ACO and OneCare Vermont
• Proprietary software tools for:
•
•
•
•
Care Coordination/Management
Quality Management
Physician/Practice Administrator Management
User Help Desks
27
Beneficiaries Don’t Join the ACO?
 Providers and provider organizations join an ACO, not
Medicare beneficiaries
 Medicare Beneficiaries assigned to a Pioneer ACO or
MSSP ACO:
Still have traditional FFS Medicare as primary payor
Can’t be in a Medicare Advantage Plan
Must have Part A and Part B Medicare coverage
Can choose any provider or provider organization that accepts
Medicare – are not locked into seeing only ACO participating
providers
 Medicare beneficiary ID card does not indicate or reference
ACO assignment




28
Do the Beneficiaries Know They’ve
Been Assigned to the ACO?
 Beneficiaries get a one-time notice in the year that they
are first assigned to a Pioneer or MSSP ACO
NOTICE TO BENEFICIARIES LETTER:
Your Doctor is Participating in an Accountable Care Organization
Excerpt
of notice
<BENEFICIARY FULL NAME>
<ADDRESS>
<CITY STATE ZIP>
<file creation date>
ACOs: A Way to Better Coordinate Your Health Care
Your doctor or primary care provider has chosen to participate in Dartmouth-Hitchcock Health, our Medicare Accountable
Care Organization (ACO). An ACO is a group of doctors, hospitals, and health care providers working together with
Medicare to give you more coordinated service and care.
We’re Working to Improve Your Care
The goal of an ACO is for your doctors or primary care providers to communicate closely with your other health care
providers, so they can deliver high-quality care that meets your individual needs and preferences. ACOs may be rewarded
for providing you with high quality, more coordinated care.
29
Can the Beneficiaries Opt-Out of
ACO Assignment?

Beneficiaries cannot opt-out of being assigned to a Pioneer ACO or MSSP ACO, but they
can opt-out of allowing CMS to share their personal health information with us



Decline to Consent to Share Information “opt-out” forms mailed out with the Notice to
Beneficiaries Letter
If they opt-out, they are still assigned to ACO but ACO will not receive any claims or clinical data
from CMS for services provided to these beneficiaries
All Medicare Beneficiaries are automatically opted-out of sharing alcohol & substance abuse data
Date: January 28, 2013
Declining to Share Personal Health Information
Excerpt
of form
Please sign this form if you do NOT want Medicare to share information about care you have received from other healthcare
providers with the Dartmouth-Hitchcock Health ACO for use in coordinating your care.
You can also call 1-800 MEDICARE (1-800-633-4227) instead of completing this form. TTY users should call 1-877-486-2048.
Your decision not to share this personal health information with the Dartmouth-Hitchcock Health ACO will remain in effect until
you tell us that you have changed your preference. You may change your decision not to share your personal information at
any time. Your request will take effect in approximately 60 business days.
Note: Even if you don’t want to share your personal information with the Dartmouth-Hitchcock Health ACO for use in
coordinating your care, Medicare will still need to use your information for some purposes, including certain financial
calculations and determining the quality of care provided by the Dartmouth-Hitchcock Health ACO. Also, Medicare may share
some of your personal health information with the Dartmouth-Hitchcock Health ACO as part of assessing the quality of care
your healthcare providers at the Dartmouth-Hitchcock ACO are providing.
30
What can Specialists do to impact
ACO models?
•
Development of “Anchor Specialists” and “Medical Neighbors”
•
•
Need for rapid consult access
•
•
•
•
Are case start times inconsistent?
Are block times altered for low volume days?
Are surgeons returning to office on low case OR days?
Are supplies and high-cost implants standardized?
Do current clinical “standard protocols” need to be revised to be more attractive in ACO environment?
•
•
•
•
Special clinics for commonly encountered problems
Special focus on fragile patients at risk for hospital care
Are bookable office hours per week available to meet this demand?
Assess OR Efficiency in order to support ACO Hospital
•
•
•
•
•
Special expertise/focus to support PCP ‘s management of chronic care conditions (e.g. heart failure “expert”
within cardiology; Vascular support from Surgery)
Diagnostic work-ups
Use of shared-decision making
Location of surgery (inpatient, hospital outpatient, ASC, other?)
Greater emphasis/involvement in post-acute care planning
•
•
Use of SNFs/rehab facilities vs. home health services
Encouraging “pre-hab” prior to surgery to potentially reduce post-acute care recovery times and increase patient
functional restoration
31
What can Specialists do to impact
ACO models?
•
Coordinate care with primary care providers
•
Encourage beneficiaries to see their primary care provider for annual Medicare
Wellness preventative care visit
•
Collaboration between primary care coordinators and specialty care
staff/nurses/care coordinators for complex patients (e.g. chronic kidney
disease, oncology) and those with rare diseases (e.g. hemophilia)
•
Enhance patient satisfaction; what patients think about their specialty care
visits matter
•
Assist in closing gaps in care
•
Emphasis on more precise coding and medical record documentation
•
Focus on quality performance measures that could be applicable to specialists
32
APPENDIX –
Pioneer ACO’s 33 Quality
Measures
33
Pioneer ACO Quality Performance Standards Measures
AIM: Better Care for Individuals
ACO #
Domain
Measure Title
NQF
Measure#
/Measure
Steward
Method of
Data
Submission
P4P
Phase-In
PY1
P4P
Phase-In
PY2
P4P
Phase-In
PY3
1.
Patient/Caregiver
Experience
CAHPS: Getting Timely Care, Appointments and
Information
NQF #5,
AHRQ
Survey
R
P
P
2.
Patient/Caregiver
Experience
CAHPS: How Well Your Doctors Communicate
NQF #5,
AHRQ
Survey
R
P
P
3.
Patient/Caregiver
Experience
CAHPS: Patients’ Rating of Doctor
NQF #5,
AHRQ
Survey
R
P
P
4.
Patient/Caregiver
Experience
CAHPS: Access to Specialists
NQF #5,
AHRQ
Survey
R
P
P
5.
Patient/Caregiver
Experience
CAHPS: Health Promotion and Education
NQF #5,
AHRQ
Survey
R
P
P
6.
Patient/Caregiver
Experience
CAHPS: Shared Decision Making
NQF #5,
AHRQ
Survey
R
P
P
7.
Patient/Caregiver
Experience
CAHPS: Getting Timely Care, Appointments and
Information
NQF #6,
AHRQ
Survey
R
R
R
8.
Care Coordination/
Patient Safety
Risk-Standardized, All Condition Readmission
CMS
Claims
R
R
P
9.
Care Coordination/
Patient Safety
Ambulatory Sensitive Conditions Admissions: COPD or
Asthma in Older Adults (AHRQ Prevention Quality
Indicator (PQI) #5)
NQF #275,
AHRQ
Claims
R
P
P
10.
Care Coordination/
Patient Safety
Ambulatory Sensitive Conditions Admissions: CHF (AHRQ
Prevention Quality Indicator (PQI) #8)
NQF #277,
AHRQ
Claims
R
P
P
11.
Care Coordination/
Patient Safety
Percent of Primary Care Physicians who Successfully
Qualify for an EHR Program Incentive Payment
CMS
EHR
Incentive
Program
Reporting
R
P
P
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting
Pioneer ACO Quality Performance Standards Measures
AIM: Better Care for Individuals
ACO #
Domain
Measure Title
NQF
Measure#/
Measure
Steward
Method of
Data
Submission
P4P
PhaseIn
PY1
P4P
Phase-In
PY2
P4P
Phase-In
PY3
12.
Care Coordination/
Patient Safety
Medication Reconciliation: Reconciliation After Discharge
from an Inpatient Facility
NQF #97,
AMAPCPI/NCQA
GPRO Web
Interface
R
P
P
13.
Care Coordination/
Patient Safety
Falls: Screening for Fall Risk
NCQA #101,
NCQA
GPRO Web
Interface
R
P
P
AIM: Better Health for Populations
ACO #
Domain
Measure Title
NQF
Measure#/
Measure
Steward
Method of
Data
Submission
P4P
PhaseIn
PY1
P4P
Phase-In
PY2
P4P
Phase-In
PY3
14.
Preventative
Health
Influenza Immunization
NQF #41,
AMA-PCPI
GPRO Web
Interface
R
P
P
15.
Preventative
Health
Pneumococcal Vaccination
NQF #43,
NCQA
GPRO Web
Interface
R
P
P
16.
Preventative
Health
Adult Weight Screening and Follow-up
NQF #421,
CMS
GPRO Web
Interface
R
P
P
17.
Preventative
Health
Tobacco Use Assessment and Tobacco Cessation
Intervention
NQF #28,
AMA-PCPI
GPRO Web
Interface
R
P
P
18.
Preventative
Health
Depression Screening
NQF #418,
CMS
GPRO Web
Interface
R
P
P
19.
Preventative
Health
Colorectal Cancer Screening
NQF #34,
NCQA
GPRO Web
Interface
R
R
P
20.
Preventative
Health
Mammography Screening
NQF #31,
NCQA
GPRO Web
Interface
R
R
P
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting
Pioneer ACO Quality Performance Standards Measures
AIM: Better Health for Populations
ACO #
Domain
Measure Title
NQF
Measure#/
Measure
Steward
Method of
Data
Submission
P4P
PhaseIn
PY1
P4P
Phase-In
PY2
P4P
Phase-In
PY3
21.
Preventative
Health
Screening for High Blood Pressure
CMS
GPRO Web
Interface
R
R
P
22.
At Risk Population
- Diabetes
Diabetes Composite (All or Nothing scoring): Hemoglobin
A1C Control (<8 percent)
NQF #729,
GPRO Web
Interface
R
P
P
At Risk Population
- Diabetes
Diabetes Composite (All or Nothing scoring): Low Density
Lipoprotein (< 100)
NQF #729,
GPRO Web
Interface
R
P
P
At Risk Population
- Diabetes
Diabetes Composite (All or Nothing scoring): Blood
Pressure (< 140/90)
NQF #729,
GPRO Web
Interface
R
P
P
At Risk Population
- Diabetes
Diabetes Composite (All or Nothing scoring): Tobacco
Non-Use
NQF #729,
GPRO Web
Interface
R
P
P
At Risk Population
- Diabetes
Diabetes Composite (All or Nothing scoring): Aspirin Use
NQF #729,
GPRO Web
Interface
R
P
P
27.
At Risk Population
- Diabetes
Diabetes Mellitus: Hemoglobin A1C Poor Control (>9
percent)
NQF #59,
NCQA
GPRO Web
Interface
R
P
P
28.
At Risk Population
- Hypertension
Hypertension (HTN): Controlling High Blood Pressure
NQF #18,
NCQA
GPRO Web
Interface
R
P
P
29.
At Risk Population
– Ischemic Vascular
Disease
Ischemic Vascular Disease (IVD): Complete Lipid Panel and
LDL Control (<100 mg/dL)
NQF #75,
NCQA
GPRO Web
Interface
R
P
P
GPRO Web
Interface
R
P
P
23.
24.
25.
26.
MN
Community
Measurement
MN
Community
Measurement
MN
Community
Measurement
MN
Community
Measurement
MN
Community
Measurement
10.
Coordination/
Ambulatory
Sensitive
Conditions Admissions:
CHF (AHRQ
NQF #277,
Note: NQFCare
= National
Quality Forum;
P4P = pay
for performance;
P = performance;
R = reporting
Patient Safety
Prevention Quality Indicator (PQI) #8)
AHRQ
Pioneer ACO Quality Performance Standards Measures
AIM: Better Health for Populations
ACO #
Domain
Measure Title
NQF
Measure#/
Measure
Steward
Method of
Data
Submission
P4P
PhaseIn
PY1
P4P
Phase-In
PY2
P4P
Phase-In
PY3
30.
At Risk Population
– Ischemic Vascular
Disease
Ischemic Vascular Disease (IVD): Use of Aspirin or Another
Antithrombotic
NQF #68,
NCQA
GPRO Web
Interface
R
P
P
31.
At Risk Population
– Heart Failure
Heart Failure: Beta-Blocker Therapy for Left Ventricular
Systolic Dysfunction (LVSD)
NQF #83,
AMI-PCPI
GPRO Web
Interface
R
R
P
32.
At Risk Population
– Coronary Artery
Disease
Coronary Artery Disease (CAD) Composite: All or Nothing
Scoring: Drug Therapy for Lowering LDL-Cholesterol
NQF #74,
GPRO Web
Interface
R
R
P
At Risk Population
– Coronary Artery
Disease
Coronary Artery Disease (CAD) Composite: All or Nothing
Scoring: Angiotensin-Converting Enzyme (ACE) Inhibitor
or Angiotensin Receptor Blocker (ARB) Therapy for
Patients with CAD and Diabetes and/or Left Ventricular
Systolic Dysfunction (LVSD)
NQF #66,
GPRO Web
Interface
R
R
P
33.
CMS
(Composite)
/AMA-PCPI
(individual
component)
CMS
(Composite)
/AMA-PCPI
(individual
component)
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting