At the end of 2015, we learned that 65 accountable care organizations (ACOs) missed out on bonus payments from CMS last year even though they generated savings for the Medicare program. The reason? They didn’t hit their target for quality measure performance required by CMS.
At the time, I couldn’t help thinking, “I wonder if those organizations were surprised by the results?”
Without a doubt, all the ACOs in Medicare’s shared savings program, including those 65, were working hard to achieve the goals of value-based care: improved care, improved health, and reduced costs. But this news highlights how hard it can be to capture and understand—let alone improve—quality performance.
Flying blind on quality measures
Organizations know they won’t succeed by cutting costs alone, then crossing their fingers and hoping for the best when it comes to quality. Still, I've been shocked by how many organizations I’ve spoken with who don’t even have a ballpark idea of what their ACO quality results will be until CMS tells them.
The two measures that gave ACOs the most trouble, avoidable admissions for heart failure patients and avoidable admissions for COPD patients, don’t require the ACO to submit any data; CMS calculates those measures from claims. While this sounds like a good thing for organizations bent double under the weight of quality reporting mandates, it’s actually a negative. It means organizations are less likely to tackle the data challenge of collecting, tracking, and trending this data themselves over the course of the performance year. Which, of course, severely hampers any efforts to improve performance in real time.
Unlike readmissions, avoidable admissions measurement doesn’t come with a list of specific patients (“You with the initial hospital discharge! You’re in!”) or a clear start and finish line (“The discharge clock starts ticking now, you have 30 days!”). That makes calculation much more difficult, since to figure out which admissions are avoidable, organizations need to track patients with chronic conditions across the continuum.
Cross-continuum tracking difficult, but necessary
If provider organizations don’t tackle the challenge of cross-continuum data collection and analysis, they won’t be able to evaluate how effectively their population health programs are working. More importantly, they won’t be able to demonstrate to other potential payer partners that they are delivering high-quality outcomes. From our vantage point, organizations jumping into the risk-based payment world must be prepared to establish cross-continuum data sharing arrangements and put quality improvement leaders in place who know how to use the data effectively.
Once the data capture mechanisms are in place, ACO leaders need to understand the key drivers behind those numbers to be able to improve. Again, robust technology solutions and a strong data analytics infrastructure are a prerequisite to success.
In the accountable care world, this means starting with an in-depth understanding of how you’re currently performing on key quality metrics, which patient populations are driving those quality results, and how you’re currently providing care to them. It all goes back to basic quality improvement principles: analyze your opportunity, set your aim, implement your changes, and measure your results.
Accurately capturing data for submission to CMS is a prerequisite for any quality reporting effort these days, but to get value (and real results), organizations need to engage with quality measures in a way that highlights improvement opportunities and provides the information necessary to drive change.
And they need to do it as quickly as possible, long before CMS informs them that they’re not getting paid.
We recently introduced Crimson Quality Reporting—a new, more robust application—to address the need for timely, actionable, and accurate cross-continuum quality measures for risk-based population health management. Find out more.