Aco quality measures pdf

Under the cms aco initiatives, before an aco can share in any savings created, it must demonstrate that it met the quality performance standard for that year. Quality measures have been a point of contention for medicares accountable care effort since it first began. Cms proposed rule describes aco quality performance standards, reporting obligations, and determination of shared savings methodology 27 april 2011 publication authors. Cms will use mssp web interface wi quality reporting to set the mips benchmarks for group practices and acos in mips that report quality via the wi.

Additional resources on aco measures for noncerner providers pdf. List of 2019 mssp aco quality measures for the cms web. Many measures are payforreporting initially then transition to payforperformance in later years. The aco quality measures align with those used in other cms quality programs, such as the physician quality reporting system and the electronic health record ehr incentive programs. Same as track 1 same as track 1 same as track 1 except, the next gen acos are exempt from aco measure 11. Linking to quality measures building the business case. Risk contracts and performance management approaches of massachusetts acos pdf 623. Quality measurement taskforce meeting 33 february 28, 2020 pdf. Technical specifications update pdf posted october 3, 2016. The aco concept is one that is still evolving, but it can be generically defined as a group of health care providers, potentially including doctors, hospitals, health plans and other health care constituents, who voluntarily come together to provide coordinated highquality care to populations of patients.

Medicare gives first glimpse of aco quality performance. Percent of pcps who successfully meet meaningful use requirements. The centers for medicare and medicaid services have updated and reduced the list of quality measures required for medicare shared savings program mssp acos reporting in 2019. Acos through the aco spotlight newsletter and update this document. Hedis 2017 measure trending determinations pdf posted march 2, 2017. Cms proposed rule describes aco quality performance. A random sample of patients is taken and their services, conditions, and diagnoses are used in order to determine the measure outcome. S priorities, such as the million hearts initiative. Minnesota community measurement mncm preventive prev care measures 6 measures individually sampled prev5. Allcause unplanned admissions for patients with heart failure. Cms will measure quality of care using nationally recognized measures in four key domains. Note that the mssp aco program is changing drastically. Hospitals and doctors rejected an early proposal for 65 measures, which the cms. The aco quality measures also align with the national quality strategy and other hhs priorities, such as the million hearts initiative.

For quality, acos will only be compared to those reporting through the wi. Medicare shared savings program accountable care organizations. Aco refers to a legal entity composed of a group of g. In developing the final rule, cms listened to industry concerns about focusing more on outcomes and considered a broad array of measures that would help to assess an acos success in delivering high. A prospective assignment would be based on the prior three years of claims weighted at 60 percent most recent, 30 percent, and 10 percent. Aco quality measures 2017 diabetes influenza immunization flu season october 1 to march 31 patients aged 6 months and older seen during flu season. Is able to effectively measure the quality and efficiency of care delivery. For each measure, the table includes 1 the aco measure number, 2 its domain of care, 3 the title of the measure, 4 its measure steward and national quality forum number if applicable, 5 the method of data submission, and 6 when the measure.

As such, the contractual arrangement exists between the aco and the mcos and not between the aco and the state. Quality measures are derived from the agency for healthcare research and qualitys ahrq pediatric quality indicators. S listened to industry concerns about focusing more. Medicare shared savings program accountable care organization aco 2018 quality measures pdf icon pdf 555 kb external icon.

Paymentsharedsavingsprogramdownloadsaconarrativemeasuresspecs. Cms measures every acos quality performance using standard methods. For information about the impact of covid19 on quality payment program qpp participation, see the quality payment program covid19 response fact sheet and subscribe to qpp updates. Quality measure data collected from the consumer assessment of healthcare. The taskforce will be tracking adoption by payers of the aligned measure set in aco contracts, and will. Performance year 2018 pdf download see 2012 2016 quality performance results table for medicare shared savings program program. Provides statistics on how pvac performs on next generation model aco quality measures for 2016 through 2018. Appendix b eohhs accountable care organization quality. Provider documentation support tools and guidance for aco. The hpc accountable care organization aco certification. Aligning aco quality scoring with mips quality scoring. Building upon experience from the pioneer aco model and the medicare shared savings program shared savings program, the next generation aco model offers an exciting opportunity in accountable careone that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. Learn more in our covid19 fact sheet cms releases final 2020 medicare physician fee schedule rule and fact sheet, including final quality measure set for acos.

Cms responds to aco concerns about smoking cessation. Aco quality measures and performance scoring methodology. Aco quality measures medicare shared savings program. Medicare shared savings program quality measure benchmarks guidance dec 2018 2 quality data reportedby shared savings program, next generation model, and pioneer model acos through the cms web interface for the 2014, 2015, and 2016 performance years. Quality measurement approaches of medicaid accountable. Accountable care organizations interested in improving quality and aligning with value. Evidence of influenza vaccine administration or documentation of reported receipt of influenza vaccine or pt. Accountable care organizations ahrq quality measures. Appendix d aco initiatives to address allpayer aco.

Accountable care organization 2012 program analysis. The law takes a carrotandstick approach by encouraging the formation of accountable care organizations acos in the medicare program. Technical specifications update pdf posted november 16, 2016. Both programs have 33 quality measures in four categories. Improving quality and lowering costs this journal of the american medical association article reveals the progress achievements of the accountable care organization aco pioneer model e. Acos are not evaluated on cost nonaco providers are evaluated on cost beginning in 2018. The aco quality measures also align with the national quality strategy and. How valuebased care is improving quality and health.

Better health valuebased care increases financial accountability and the level of integration between health plans and care providers. Below is the list of 2019 mssp measures that acos will need to report via the cms web interface. Aco 2018 quality measure narratives overview the aco quality measures are reported to cms at the beginning of each year for all patient encounters for the prior year. Aco 2018 quality measure narratives north country initiative. Quality performance results dallas fort worth, texas tx. Medicare by meeting established quality metrics and. Aco can choose either prospective or retrospective assignment. Urac reserves the right to update its measures and measure sets to maintain measure relevancy and to remedy any unintended consequences that may arise during implementation. Learn about the massachusetts aligned quality measure set. Accountable care organizations acos are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the medicare patients they serve. Accountable care organizations, explained kaiser health news. Cystic renal lesion that is simple appearing bosniak i or ii adrenal lesion less than or equal to 1. Acolike network that receives capitated payments from medicaid mcos.

Guidelines for success in 2017 aco quality reporting domain number of individual measures total measures for scoring purposes total possible points domain weight patientcaregiver experience 8 8 individual survey module measures 16 25% care coordinator patient safety 10 10 measures, the electronic health record measure is double weighted 4. Organizations that have already earned accreditation will maintain their status through their expiration date. Yearly, onecare develops a quality work plan which includes quality assurance activities, performance measurement and performance improvement. Sources of measure documentation by measure type and links for 2019 documentation.

View the quality measures that accountable care organizations aco must report to cms after the close of every performance year to be eligible to share in any earned shared savings. This reference shows the 31 quality measures used to assess aco quality performance and the quality performance standard for the 2018 performance year for the shared savings program. Rob merrill visited london not long ago, he noted all the mind the gap signs in the subway. Cms measures every aco s quality performance using standard methods. Mcac 2019 quality update utah medicaid aco quality measures. The aco quality measures are reported to cms at the beginning of each year for all patient encounters for the prior year. Status report on medicare accountable care organizations. Further, urac may add andor align its measures with regulatory requirements of federal, state, and local governments. Medicaid aco pediatric quality measures and innovative. The quality scores for 2019 will be posted in 2020 provides details of an arrangement pvac has with physicians serving aligned beneficiaries in skilled nursing facilities and regarding pvacs home visit program see public disclosure. The data for these patient encounters comes from three distinct locations. For a listing of the organizations currently accredited, visit the ncqa report cards.

Instead, we urge cms to maintain the current vaccination measure aco14. Ncqa has retired the accountable care organization aco accreditation effective october 25, 2019. Annual monitoring for patients on persistent medications. How acos in massachusetts manage population health pdf 563. Coronary artery disease 2 measures the 33 quality measures are provided ataglace in table 1. National committee for quality assurance ncqa mental health mh disease measure. Allcause unplanned admissions for patients with multiple chronic conditions. Aco quality assessed predominantly on process measures acos have consistently high overall quality scores but in all aco models, more than half of measures are process measures on populationbased outcome and patient experience measures, acos maintain at least average results mssp acos. How one small practice achieved all aco quality goals.

Quality measure benchmarks for the 20182019 performance year document. As a result of naacos advocacy, cms has extended the aco quality reporting deadline and mips reporting deadline to april 30, 2020 due to the covid19 pandemic. Cahps surveys o these are sent by a third party vendor rms and all. The aco quality measures also align with the national. Percentage of adults with usual primary care provider medicare aco composite of 5 questions on getting timely care, appointments and information. Accountable care organization 2016 program quality measure. The impact of accountable care national partnership.