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ACO Foundational Data andInformation Technology Needs
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ACOs under the Medicare Shared Savings Program and the Role of Health IT
Speaker BioShelley Price, MS
Director, Payer and Life SciencesHIMSS
Conflict of Interest Disclosure
Shelley Price, MSy ,
• Have no real or apparent conflicts of interest to report.
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Learning ObjectivesACOs under the Medicare Shared Savings
Program and the Role of Health ITg
Understand the basics of a Medicare ACO under the proposed CMS rulemaking
• What is an ACO?
– Must be a legal entity
– Have an taxpayer identification number
MSSP ACOs: Definitions
– Be comprised of eligible group of ACO participants• ACO professionals in group practices
• networks of individual practices of ACO professionals
• partnerships or joint venture arrangements between hospitals and ACO professionals
• hospitals employing ACO professionals
• other groups of providers of services and suppliers as determined by the Secretary
– Have a mechanism for shared governance5
• Program– Voluntary program; extensive application required
– 3‐year contract required; begins January 1, 2012
St f i PCP t b l t 1 ACO
MSSP ACOs: Program and Governance
– Strong focus on primary care; PCP must be excl to 1 ACO
– MU requirement: 50% of PCPs by yr 2
• Governing Body– Broad authority & responsibility for administrative, fiduciary, & clinical operations
– Proportional representation of ACO participants• at least 75% are “participants”, i.e. providers such as MDs, PAs, NPs
• at least 1 Medicare beneficiary 6
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• Medicare FFS population
• Retrospective assignment to an ACO
Not an opt in; assigned at the end of the year
MSSP ACOs: Beneficiaries
– Not an opt‐in; assigned at the end of the year
– Based on plurality of primary care to an ACO participant
• Patient may opt‐out
– ACO provider
– PHI
• Minimum number of benes in ACO: 5,000
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• 1‐sided risk model– Yr 1‐2: sharing in savings only; Yr 3: add in shared losses
– Savings based on quality performance up to 50% savings
Y 3 l 5%
MSSP ACOs: Risk – 2 Models
– Yr 3 losses max: 5%
– Bonus up to 2.5% for rural clinics, FQHCs
• 2‐sided risk model– Yr 1‐3: sharing in both savings & losses
– Savings based on quality performance up to 60% savings
– Yr 3 losses max: 10%
– Bonus up to 5.0% for rural clinics, FQHCs8
• Estimated Participation
– ACOs: 75‐150
– Beneficiaries: 1.5‐4.0M
MSSP ACOs: By the Numbers
e e c a es 5 0
• Costs and Savings (3 years)
– Total savings: $510M (Federal)
– Bonuses to ACOs: $800M
– Penalties from ACOs: $40M
– Average ACO startup cost incl 1st yr operating: $1.73M
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Speaker BioAlan Gilbert, MPA
AxSys TechnologyVice President, Business
Development
Conflict of Interest Disclosure
Alan Gilbert, MPA,
• Have no real or apparent conflicts of interest to report.
Learning ObjectivesACOs under the Medicare Shared Savings Program and the Role ofSavings Program and the Role of
Health IT
ACO Foundational Data and Information Technology Needs
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Data Needs for ACO Environment
Data to be shared from:
• CMS to ACOs
• ACOs back to CMS
• Within the ACO itself
42 CFR Part 425 [CMS‐1345‐P]RIN 0938‐AQ22 Medicare Program; Medicare Shared Savings Program:
Accountable Care Organizations
Data Needs for ACO Environment
Data to be shared from:
• CMS to ACOs
–CMS will share
•aggregate data
•Beneficiary identifiable data42 CFR Part 425 [CMS‐1345‐P]
RIN 0938‐AQ22 Medicare Program; Medicare Shared Savings Program:Accountable Care Organizations
Data Needs for ACO Environment
Data to be shared from:
• ACOs back to CMS
– ACOs have focus on Quality
C S id ifi d 2 Q li h K i– CMS identified 2 Quality Themes, 5 Key Domains, and 65 Measures within the dimensions of improved care and improved health that CMS proposes will serve as the basis for assessing, benchmarking, rewarding, and improving ACO quality performance.
42 CFR Part 425 [CMS‐1345‐P]RIN 0938‐AQ22 Medicare Program; Medicare Shared Savings Program:
Accountable Care Organizations
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Quality Themes , 5 Key Domains and 65 Measures
Quality Themes• Better Care for Individuals • Better Health for Populations
Key DomainsKey Domains• Patient/Caregiver Experience• Care Coordination• Patient Safety• Preventive Health• At‐Risk Population/Frail Elderly Health
42 CFR Part 425 [CMS‐1345‐P]RIN 0938‐AQ22 Medicare Program; Medicare Shared Savings Program:
Accountable Care Organizations
65 Measures
Quality Reporting and Performance
• 65 measures
– Patient/Caregiver Experience (7)
– Care Coordination (16)
– Patient Safety (2)Patient Safety (2)
– Preventive Health (9)
– At‐Risk Population/Frail Elderly (31)
• Required to Submit on allmeasures
– Yr 1: report only
– Yr 2‐3: measured on performance42 CFR Part 425 [CMS‐1345‐P]
RIN 0938‐AQ22 Medicare Program; Medicare Shared Savings Program:Accountable Care Organizations
65 Measures Quality Reporting and Performance
Page 1 of the 65 Measures
42 CFR Part 425 [CMS‐1345‐P]RIN 0938‐AQ22 Medicare Program; Medicare Shared Savings Program:
Accountable Care Organizations
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Data Needs for ACO Environment
Data to be shared from:• Within the ACO itself
– Longitudinal/Community Health Record – EMPI
l h f h ( )– Health Information Exchange (HIE) – Hierarchical Data Security – Collaborative Clinical Decision Support – Provider‐to‐Provider Communication Tools – Integrated Workflow Management – Active Care Management
HIMSS ACO Workgroup – Chapter 4 – ACO Management Tools FAQ
Where will this data come from
to satisfy these requirements?
Speaker BioKobi Margolin
ClinigenceClinigenceCEO
• Cofounder and GM US Operations, Algotec (sold to Kodak, 2004)
• VP Business Development, Accelarad(2005‐2008)
• Founder, KM Consulting Group (2008)
• Founder and CEO, Clinigence (2010)
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Conflict of Interest DisclosureKobi Margolin
• Have no real or apparent conflicts of interest
Learning ObjectivesACOs under the Medicare Shared Savings Program and the Role ofSavings Program and the Role of
Health IT
• Analytics for ACOs –Data and Technology Needs
Why Analytics?
Can this be the road to
accountable care?!
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Data
Actionable Information
The Value of Analytics
Knowledge
Clinical Analytics
Actionable Information
Data
Knowledge
Clinical Analytics
Actionable Information
• Claims
• EMR
Data
Knowledge• Timely
• Relevant
• Complete
• Accurate
• Process (guidelines, interventions)
• Outcome (benchmarks)
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Which Technologies?
Actionable Information
• Acquisition
• Aggregation
Data
Knowledge• Visualization
• Management
Analytics
Value/Type Claims EMR HIE/Cross‐EMR
Cost C i
What Data?
Care continuum ‐ Patient outcomes ‐ Actionable ‐
Acquisition & Aggregation
Remote
Semantic interoperability
Electronic claims; disease registries
EMRs; Clinical Data Repository
Health information exchange
Remote monitoring; personal health records
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Creating Knowledge
Research Insight
Knowledge
Data
Information
Action
Knowledge Management
Semantic;
Content Management; Clinical decision support
Collaboration; social networking
Semantic; ontology‐based
Care Improvement
Staff
• Staff performance
• Process effectiveness
Innovation & Learning
Process
effectiveness
• Innovation & learning of best practices
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Analytics Technologies
Population h lth
Process ‐outcome
Predictive modeling
Data mining
Process intelligence
Provider‐centric quality reporting
Provider performance analysis
Population outcomes (health; cost) analysis
health management
Process compliance mapping
analysis
Business intelligence
• Benchmarking
Visualization Technologies
• Benchmarking
• Trending
– Retrospective
l i ki
Visualization Technologies
– Real‐time tracking
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• Benchmarking
• Trending
– Retrospective
l i ki
Visualization Technologies
– Real‐time tracking
• Population mapping
• Interactive data mining
• Real‐time feedback loops
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