Transcript
Page 1: Improving Quality of Care for Medicare Patients: …garnerhealth.com/.../2011/11/Improving-Quality-of-Care.pdfImproving Quality of Care for Medicare Patients: Accountable Care Organizations

DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services

Improving Quality of Care for Medicare Patients:

Accountable Care OrganizationsFACT SHEET http://www.cms.gov/sharedsavingsprogram

Overview

On October 20, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the 'HSDUWPHQW�RI�+HDOWK��+XPDQ�6HUYLFHV��++6���¿QDOL]HG�QHZ�UXOHV�XQGHU�WKH�$IIRUGDEOH�&DUH�$FW�to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients WKURXJK�$FFRXQWDEOH�&DUH�2UJDQL]DWLRQV��$&2V���$&2V�FUHDWH�LQFHQWLYHV�IRU�KHDOWK�FDUH�SURYLGHUV�WR�ZRUN�WRJHWKHU�WR�WUHDW�DQ�LQGLYLGXDO�SDWLHQW�DFURVV�FDUH�VHWWLQJV�±�LQFOXGLQJ�GRFWRU¶V�RI¿FHV��KRVSLWDOV��DQG�ORQJ�WHUP�FDUH�IDFLOLWLHV��7KH�0HGLFDUH�6KDUHG�6DYLQJV�3URJUDP��6KDUHG�6DYLQJV�3URJUDP��ZLOO�UHZDUG�$&2V�WKDW�ORZHU�WKHLU�JURZWK�LQ�KHDOWK�FDUH�FRVWV�ZKLOH�PHHWLQJ�SHUIRUPDQFH�VWDQGDUGV�RQ�TXDOLW\�RI�FDUH�DQG�SXWWLQJ�SDWLHQWV�¿UVW��3URYLGHU�SDUWLFLSDWLRQ�LQ�DQ�$&2�LV�SXUHO\�YROXQWDU\�

,Q�GHYHORSLQJ�WKLV�¿QDO�UXOH��&06�ZRUNHG�FORVHO\�ZLWK�DJHQFLHV�DFURVV�WKH�)HGHUDO�JRYHUQPHQW�WR�ensure a coordinated and aligned inter- and intra-agency effort to facilitate implementation of the Shared 6DYLQJV�3URJUDP�

&06�HQFRXUDJHV�DOO�LQWHUHVWHG�SURYLGHUV�DQG�VXSSOLHUV�WR�UHYLHZ�WKLV�¿QDO�UXOH�DQG�FRQVLGHU�SDUWLFLSDWLQJ�LQ�WKH�6KDUHG�6DYLQJV�3URJUDP�

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ACO Final Quality Measures and Performance Scoring Methodology

Quality Measures:�7KH�¿QDO�UXOH�DGRSWV����LQGLYLGXDO�PHDVXUHV�RI�TXDOLW\�SHUIRUPDQFH�WKDW�ZLOO�EH�XVHG�WR�GHWHUPLQH�LI�DQ�$&2�TXDOL¿HV�IRU�VKDUHG�VDYLQJV��7KHVH����PHDVXUHV�VSDQ�IRXU�TXDOLW\�GRPDLQV��3DWLHQW�([SHULHQFH�RI�&DUH��&DUH�&RRUGLQDWLRQ�3DWLHQW�6DIHW\��3UHYHQWLYH�+HDOWK��DQG�$W�5LVN�3RSXODWLRQ��7KH�OLVW�RI�PHDVXUHV�LV�LQFOXGHG�DV�DQ�DSSHQGL[�WR�WKLV�IDFW�VKHHW��

1

ICN 907407 October 2011

Page 2: Improving Quality of Care for Medicare Patients: …garnerhealth.com/.../2011/11/Improving-Quality-of-Care.pdfImproving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

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,Q�GHYHORSLQJ�WKH�¿QDO�UXOH��&06�OLVWHQHG�WR�LQGXVWU\�FRQFHUQV�DERXW�IRFXVLQJ�PRUH�on outcomes and considered a broad array of measures that would help to assess DQ�$&2¶V�VXFFHVV�LQ�GHOLYHULQJ�KLJK�TXDOLW\�KHDOWK�FDUH�DW�ERWK�WKH�LQGLYLGXDO�DQG�SRSXODWLRQ�OHYHOV��&06�DOVR�VRXJKW�WR�DGGUHVV�FRPPHQWV�WKDW�VXSSRUWHG�DGRSWLQJ�IHZHU�WRWDO�PHDVXUHV�WKDW�UHÀHFW�SURFHVVHV�DQG�RXWFRPHV��DQG�DOLJQLQJ�WKH�PHDVXUHV�ZLWK�WKRVH�XVHG�LQ�RWKHU�TXDOLW\�UHSRUWLQJ�SURJUDPV��VXFK�DV�WKH�3K\VLFLDQ�4XDOLW\�5HSRUWLQJ�6\VWHP�

Reporting:�7KH�PHDVXUHV�ZLOO�EH�UHSRUWHG�WKURXJK�D�FRPELQDWLRQ�RI�D�ZHE�LQWHUIDFH�GHVLJQHG�IRU�FOLQLFDO�TXDOLW\�PHDVXUH�UHSRUWLQJ�DQG�SDWLHQW�H[SHULHQFH�RI�FDUH�VXUYH\V��,Q�DGGLWLRQ��&06�FODLPV�DQG�DGPLQLVWUDWLYH�GDWD�ZLOO�EH�XVHG�WR�FDOFXODWH�RWKHU�PHDVXUHV�LQ�RUGHU�WR�UHGXFH�DGPLQLVWUDWLYH�EXUGHQ��&06�ZLOO�DOVR�DGPLQLVWHU�DQG�SD\�IRU�WKH�SDWLHQW�H[SHULHQFH�RI�FDUH�VXUYH\�IRU�WKH�¿UVW���\HDUV�RI�WKH�6KDUHG�6DYLQJV�3URJUDP�������DQG�������$&2V�ZLOO�EH�UHVSRQVLEOH�IRU�VHOHFWLQJ�DQG�SD\LQJ�IRU�D� &06�FHUWL¿HG�YHQGRU�WR�DGPLQLVWHU�WKH�SDWLHQW�VXUYH\�EHJLQQLQJ�LQ������

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Quality Performance Scoring:�$V�UHTXLUHG�E\�WKH�$IIRUGDEOH�&DUH�$FW��EHIRUH�DQ�$&2�FDQ�VKDUH�LQ�DQ\�VDYLQJV�FUHDWHG��LW�PXVW�GHPRQVWUDWH�WKDW�LW�PHW�WKH�TXDOLW\�SHUIRUPDQFH�VWDQGDUG�IRU�WKDW�\HDU�

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Page 3: Improving Quality of Care for Medicare Patients: …garnerhealth.com/.../2011/11/Improving-Quality-of-Care.pdfImproving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

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or above 90 percent or the 90th�SHUFHQWLOH�RI�WKH�SHUIRUPDQFH�EHQFKPDUN�ZLOO�HDUQ�WKH�PD[LPXP�SRLQWV�DYDLODEOH�IRU�WKH�PHDVXUH�

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Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

Appendix

Quality Measures for Accountable Care Organizations

Domain Measure TitleNQF Measure

#/Measure Steward

Method of Data

Submission

Pay for Performance Phase InR = Reporting P = Performance

Performance Year 1 Year 2 Year 3

AIM: Better Care for Individuals

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Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

Domain Measure TitleNQF Measure

#/Measure Steward

Method of Data

Submission

Pay for Performance Phase InR = Reporting P = Performance

Performance Year 1 Year 2 Year 3

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Adult Weight Screening and Follow-up

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Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

Domain Measure TitleNQF Measure

#/Measure Steward

Method of Data

Submission

Pay for Performance Phase InR = Reporting P = Performance

Performance Year 1 Year 2 Year 3

21. Preventive Health

Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding 2 years

CMS GPRO Web Interface

R R P

22. At Risk Population – Diabetes

Diabetes Composite (All or Nothing Scoring): Hemoglobin A1c Control (<8 percent)

NQF #0729

MN Community Measurement

GPRO Web Interface

R P P

23. At Risk Population – Diabetes

Diabetes Composite (All or Nothing Scoring): Low Density Lipoprotein (<100)

NQF #0729

MN Community Measurement

GPRO Web Interface

R P P

24. At Risk Population – Diabetes

Diabetes Composite (All or Nothing Scoring): Blood Pressure <140/90

NQF #0729

MN Community Measurement

GPRO Web Interface

R P P

25. At Risk Population – Diabetes

Diabetes Composite (All or Nothing Scoring): Tobacco Non Use

NQF #0729

MN Community Measurement

GPRO Web Interface

R P P

26. At Risk Population – Diabetes

Diabetes Composite (All or Nothing Scoring): Aspirin Use

NQF #0729

MN Community Measurement

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): Blood Pressure Control

NQF #18

NCQA

GPRO Web Interface

R P P

29. At Risk Population – Ischemic Vascular Disease

Ischemic Vascular Disease (IVD): Complete /LSLG�3UR¿OH�DQG�/'/�Control <100 mg/dl

NQF #75

NCQA

GPRO Web Interface

R P P

6

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Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

Domain Measure TitleNQF Measure

#/Measure Steward

Method of Data

Submission

Pay for Performance Phase InR = Reporting P = Performance

Performance Year 1 Year 2 Year 3

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Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

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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)

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Improving Quality of Care for Medicare Patients:

Accountable Care Organizations

Official CMS Information forMedicare Fee-For-Service Providers

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