Bellin Health shares how the health system achieved the top composite quality score in the first performance year of Next Generation ACO.
While the Next Generation ACO program has generated modest financial gains, top-performing participants are posting strong quality metric scores.
Next Generation ACO has more than 30 quality measures, including access to specialists, medication reconciliation, and depression screening.
In quality performance, Bellin Health was the top quality metrics performer in the first year of Next Generation ACO. In 2016, the Green Bay, Wisconsin–based health system posted the highest composite score (64.54% out of a potential 100%) for the ACO's quality measures and registered shared savings totaling $1,400,148.
Chris Elfner, director of accountable care strategies at Bellin Health, says quality and shared savings should not be competing goals.
"High-quality care attains shared savings. A lot of providers start with their high-cost, high-risk patients and try to put all kinds of extra resources on them, but if you take a full-population view, you get paid on the low-cost, low-risk patients," he says.
He continues, "You benefit from keeping patients low cost and low risk. The way you do that is by achieving quality—by closing care gaps, by managing chronic conditions, and by making sure people are taking care of their health. Although that approach raises the cost of care in some areas for low-cost, low-risk patients, it lowers the total cost of care, which generates shared savings."
Bellin Health shares its strategies to scoring well in the quality measures for Medicare's newest accountable care model.
1. Internal tracking of quality performance
Bellin Health participates in several ACO contracts. To avoid an overwhelming administrative burden, the health system tracks quality metric performance according to internal standards, which capture most of the Next Generation measures, Elfner says. "We are tracking in real time. We have dashboards built into our Epic system that are tracking the Next Gen ACO metrics—not exactly, but we track the critical metrics in a way we feel they should be calculated."
Tracking the ACO quality metrics at the patient level is essential to encourage providers to achieve quality metrics, he says.
"It's tracked at the point of care—at the patient level. When a provider or clinician brings up a patient chart, there is a sidebar report that has all of the quality measures [symbolized] as red, green, or not applicable. They can see that information, and we have other information in that sidebar such as whether the provider is in the Next Gen ACO. For us, that means [the providers] are eligible for waivers and the $25 wellness visit payment," Elfner says.
Physicians can view the quality metrics from a pair of perspectives, he says. "When they log in, providers see those metrics for their panel of patients, or the population for their specialty."
Tracking quality data in real time also gives Bellin Health the ability to identify and influence low-performing clinicians in a timely manner, says Naomi Wedin, executive director of Bellin Health Partners.
"We rely heavily on the physicians and the physician leaders that we have in the organization. They talk with their peers and get their peers to understand the importance of why things need to be done—not just from a reporting standpoint but also from the standpoint of the overall care of the patient," she says.
Metrics data helps drive those conversations.
"We provide information that helps support the need to have various quality measures achieved. For example, there are annual wellness visits for the Next Gen population, and this is one of the ways we close care gaps and meet quality measures," Wedin says.
2. Solitary measurement
At Bellin Health, a simplified approach to quality measurement is an important element of success in the Next Generation ACO quality scores.
"Our approach to quality measures has always been that we needed to define quality for our care in a single and solitary way; so, rather than looking at HEDIS metrics and Next Gen metrics, we have a collaborative here in Wisconsin called the Wisconsin Collaborative for Healthcare Quality that has slightly different versions of the same metrics," Elfner says.
The solitary approach is better for physicians and the health system, he says.
For example, he says Bellin wants to avoid having providers working with multiple quality metrics for a single clinical measure such as A1C control. "We have always defined quality internally and tried to achieve whatever that quality is, then match those metrics to the payer-contracted metrics. To me, that's the biggest best practice," Elfner says.
3. Understanding the data
Comprehension and capabilities are crucial to success in Next Generation ACO quality measures, he says.
"As a contract starts, you need to understand what the quality metrics are and what needs to be captured to meet those quality metrics. Then, you need to make sure the system and the EMR can capture those metrics. The next question is whether we have an [administrative] process in place to capture those metrics. The last question is whether we have an automated way of calculating," Elfner says.
The Next Generation ACO program is geared to generate accurate information, and Bellin Health has seized on the opportunity that the high-quality data presents, Elfner says.
"[Next Gen's ACO] quality metrics do not vary drastically from any other quality metrics we look at. What the Next Gen ACO gives us, such as claims files, is by far the best information we get from any ACO. It is the cleanest, it's the most consistent, and it's the most useful. We would encourage all private and commercial payer organizations to mimic Next Gen ACO."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
For quality measures in the 2016 performance year of Next Generation ACO, Bellin Health posted the highest composite score at 64.54%.
Bellin takes a simplified approach to quality metrics, with a focus on an internal set of quality measures that only approximates the metrics for Next Generation ACO and other accountable care contracts.
Under Bellin's accountable care philosophy, shared savings and quality performance are not competing goals.