As I am writing the 1st Edition of the ACO Survival Guide and reflecting on the need for comprehensive patient data to monitor clinical, operational and financial metrics, I chose to create an interactive test file of the median cost of Primary Care in Pinellas County Florida for calendar year 2012. The following interactive graphic provides costs by zip code.
Data was publically downloaded from the CMS Website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Calculations.html that provides data for applicants to the Medicare Shared Savings Program to calculate their share of services in each applicable Primary Service Area. In addition, the CMS data sets include all physician fee-for-service claims for calendar year 2012. General Practice, Family Practice, Internal Medicine, and Geriatric Medicine, are combined into the Primary Care category and charges under this category represent all of these specialties.
As part of the Masters Program in Health Informatics, I produced videos on The Role of Informatics for Accountable Care Organizations. Links are below. I will be updating this post with videos each week.
Key Learning Objectives are:
Link: Modern Healthcare
The Affordable Care Act (ACA) authorized the Secretary of the Department of Health and Human Services (HHS) to enter into agreements with Accountable Care Organizations (ACOs) on a shared savings basis with the goals of improved health outcomes and efficiency. Medicare Shared Savings Program (MSSP) ACOs are measured on the quality of the patient experience, preventive care and disease management and some of the leading causes of death among U.S. elderly.
In September 2014, Modern Healthcare reported that CMS released results of each ACOs’ financial performance. Of the approximately 200 ACOs, 53 reduced the cost of patient care enough to share $300 million in bonuses. These results are a significant development in Medicare cost reduction. A link to the PDF is here.
In order to monitor quality measures and metrics to achieve these goals, investment in infrastructure and redesigned care processes may have been used to monitor care provided to Medicare beneficiaries. Infrastructure might include a data warehouse that syncs data from EMRs to provide monitoring capabilities for performance standards and metrics. A data warehouse model might look like the picture below, where the ACO gathers data from a variety of sources to monitor and benchmark performance.
Link: New ACOs
According to a news release in Healthcare Finance, " The number of accountable care organizations in Medicare’s Shared Savings Program will grow by 89 in January 2015, the Centers for Medicare and Medicaid said this week, boosting the total participants to 405.
Participating ACOs will now serve more than 7.2 million patients."
Section 3022 of the Patient Protection and Affordable Care Act required CMS to establish a shared savings program to facilitate coordination and cooperation among providers. The shared savings provision of the ACO model is designed to encourage participating providers to redesign their practice workflow and includes a focus on improved health for populations.
When an ACO succeeds in both delivering high-quality care and spending wisely by avoiding unnecessary duplication of services, it will share in the savings it provides for the Medicare program. ACO’s can participate in Medicare shared savings, but the flip side is that they can also share in Medicare losses if their costs do not meet established benchmarks. Shared savings begins on the first dollar for all ACOs once the minimum savings rate has been achieved.