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ACOs Looking to Expand Population Health Management Capabilities, Report Finds

October 27, 2016
by Rajiv Leventhal
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Study of 19 ACOs finds that further aligning providers with the community will be key for improvement

As accountable care organizations (ACOs) continue to progress, they are seeking to expand population health management capabilities, including their relationships with community organizations and patients, according to new research from Charlotte, N.C.-based Premier, Inc.

The report, with support from the Robert Wood Johnson Foundation (RWJF), collected qualitative and quantitative information from 19 fully-integrated ACOs that participate in Premier’s Population Health Management Collaborative to understand the current state of ACO development and implementation, and identify barriers and potential solutions.

According to the researchers, review of the qualitative findings yielded a number of overarching themes that capture opportunities, challenges and outcomes as organizations develop and implement ACOs. For instance, while nearly every ACO studied is working with community social service organizations, 84 percent cited increased support from their community partners as an opportunity for improvement that is very different from the work that hospital-based organizations have traditionally considered. This includes moving to serve as the central hub to enable community organizations to be more effective in meeting the needs of mentally ill and chemically addicted residents, as well as teaming with employers and local gyms to offer exercise and nutrition-based counseling to address preventative health needs, the report stated.

"Increasingly, providers understand how important the things that happen outside of the doctor's office or hospital are to improving and managing a person's health,” said Andrea Ducas, program officer at RWJF. "To that end, some leading ACOs are expanding their services to include more upstream, preventive support for patients and are also expanding their work to reach entire communities, rather than just focusing on their assigned beneficiaries.”

Joe Damore, vice president of population health management at Premier, added, “What can get lost in discussions is the impact of the social determinants of health on how well ACOs perform. This analysis reveals real-world efforts underway when it comes to the importance of community partnerships to influence health outcomes and performance. We’re seeing our members collaborate with organizations like Meals on Wheels to improve the health of their populations.”

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Nearly all ACOs reported using two approaches to improve population health: improving care for all high-risk patients in their attributable population; and improving care to patients with a specific disease state to target in their attributable population. Other common approaches included: helping to ensure that primary care providers use a patient-centered medical home (PCMH) model; and improving health outcomes for the entire geographic area that they serve. Less than half of survey participants use two other approaches: improving the conditions for health in their community; and helping providers become certified PCMHs.

What’s more, there are different levels of maturity among ACOs. Some are struggling with financial pressures and payer requirements related to the specific populations for which they are accountable. Only 32 percent of respondents reported that their communities had adequate resources to meet the challenge of improving community health. Limitations include, inadequate funding for staffing and services, data interoperability challenges, physicians operating under the fee-for-service model, and payer pressures.

Most of the ACOs studied are participating in the Medicare Shared Savings Program (MSSP) and a commercial ACO or shared savings program. Half of the Medicare ACOs in Premier’s Population Health Management Collaborative qualified for shared savings payments in performance year 2015. To this end, Centers for Medicare & Medicaid Services (CMS) Medicare ACO data from 2015, released in August, MSSP ACOs generated total savings of $429 million in 2015, though just 119 of the 392 organizations (30 percent) earned shared savings by holding spending far enough below their financial benchmarks and meeting quality standards. ACOs with more experience in the Medicare Shared Savings Program also tend to perform better over time, according to CMS’ results.

Researchers in this report also identified three ways ACOs are engaging to meet the ongoing and future challenges of population health and value-based payment models:

  • Improving information and best practice sharing with other ACOs.
  • Developing a framework for implementing population health improvement activities based on level of maturity and access to required community resources.
  • Enhancing dialogue between providers, regulators and funders to set priorities for services development and future research foci.

“Alternative payment models, such as ACOs, serve to shift the traditional fee-for-service model, which incents providers to do more rather than do better, to a value-based model that aligns incentives with measurable quality, cost and population health outcomes,” said Timothy Lowe, Ph.D., director, healthcare research, Premier Research Institute, the study’s principal investigator. “As providers develop and implement alternative payment models to align with value-based payment policies, such as the new Quality Payment Program for physicians, it is critical to identify what is working and what is not to support continuous change and improvement.”

A quantitative analysis, which compares differences in patient outcomes and care costs between the 19 ACO systems and a matched sample of their non-ACO peers, will be published in a separate report, according to officials.


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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”

 

 

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In this webinar, we will review how tumor board solutions, precision medicine frameworks, and oncology pathways are being used within clinical quality programs as well as understanding their role in driving operational improvements and increasing patient retention. We will demonstrate the requirements around both interoperability and the clinical depth needed to ensure adoption and effective capture and use of information to accomplish these goals.

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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.

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Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.

 

 


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