ACO Compliance and Quality Improvement Committee Physician Participants Needed

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Thomasina Goodman
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1 September 2017 In this issue: ACO Compliance and Quality Improvement Committee: Physician Participants Needed CHI St. Joseph Health Partners Quarter 2 ACO Performance ACO Quality Metric Spotlight Pneumococcal Vaccine ACO Compliance and Quality Improvement Committee Physician Participants Needed Statement of Purpose: The CHI St. Joseph Health Partners ACO Compliance and Quality Improvement Committee will develop, identify, and monitor clinical evidencebased measures, utilization metrics and ACO initiatives for services across the continuum of care. The committee will assist the CHI St. Joseph Health Partners ACO Board of Directors in its responsibilities as related to ACO priorities to achieve the threepart aim: better care for individuals, better health for the population, and lower cost. Membership: The committee will be comprised of 7 ACO participants representing primary and specialty care. The Board may elect to adjust the committee s size for the long-term and/or from time to time for specific ACO initiatives. Responsibilities and Duties: The committee shall recommend processes, pathways, and bundles of care and services to ensure: Superior quality and patient safety Appropriate utilization of resources Improved patient outcomes

2 Short dashboards for providers and leaders that reflect current status of compliance and quality Recommend to the Board if action is required to remediate physicians who are not in compliance with the quality standards of the ACO If you are interested in joining this committee, please contact Reyann Davis at CHI St. Joseph Health Partners ACO Performance Quarter Key Performance Indicators a. -distributed Home Health Utilization From April 2015 March 2016, the ACO s home health expenditures were $1,056 per beneficiary and $2.6 million over the national average. In an effort to reduce expenditures, there have been several initiatives implemented toward reviewing and tracking home health recertifications. As a result of these initiatives, home health expenditures from April 2016 June 2017 have dropped by $94 per beneficiary to $962. While the national average is $646 per beneficiary, our efforts are moving the trend in the right direction. Furthermore, we have discharged 128 patients from home health services who were determined to be unsuitable for home health services. Risk Score A patient s risk score starts over at zero at the beginning of every calendar year, which explains the graph pattern above. Because a patient s risk score starts at zero every January, providers are responsible for making sure that their patients conditions are recoded every year. If the patient is not re-coded, the patient s risk score will drop, making the patient appear healthier than they really are. Quarter showed an average risk score of 0.97 for our patient population, compared to 0.89 in Quarter As of June, 55% of patients who were coded for diabetes, COPD, or morbid obesity in 2016 have been coded in Similarly, only

3 44% of patients who were coded for any chronic disease in 2016 have been coded in It is important to accurately capture a patient s risk score because CMS compensates ACOs for the risk of their attributed patients instead of calculating an average amount for their beneficiaries. Risk scores measure an individual beneficiary s relative risk and adjust payments for each beneficiary s expected expenditures. Obtaining an accurate risk score, and therefore an accurate benchmark, relies heavily upon how well an ACO understands and documents the true health of its patient population. Medicare Annual Wellness Visits The Medicare Annual Wellness Visits provide an opportunity for the patient and the provider to develop, assess, and update a patient s personalized prevention plan to help prevent disease and disability based on current health and risk factors. The wellness visit can also serve as an opportunity for the patient s conditions to be re-coded from the previous year. Over the last 12 months July 2016 June 2017), 28% of our Medicare beneficiaries had been seen for a wellness visit which is an increase from the previous 12 months ( ) where only 10% of our Medicare beneficiaries had a wellness visit. ACO Quality Metric Spotlight There are a total of 15 individual measures targeting high-cost chronic conditions, preventive care, and patient safety included in 2017 Medicare ACO quality reporting. This month s focus measure is Pneumococcal Vaccination. Pneumococcal Vaccination Rationale: Pneumonia is a common cause of illness and death in the elderly and persons with certain underlying conditions such as heart failure, diabetes, cystic fibrosis, asthma, sickle cell anemia, or chronic obstructive pulmonary disease. Among the 91.5 million US adults aged > 50 years, 29,500 cases of invasive pneumococcal disease, 502,600 cases of nonbacteremic pneumococcal pneumonia and 25,400 pneumococcal-related deaths are estimated to occur yearly; annual direct and indirect costs are estimated to total $3.7 billion and $1.8 billion, respectively.

Vaccination has been found to be effective against bacteremic cases as well as nonbacteremic cases. Pneumococcal immunization rates for adults 65+ are below Healthy People 2020 Goals.

4 Vaccination has been found to be effective against bacteremic cases as well as nonbacteremic cases. Pneumococcal immunization rates for adults 65+ are below Healthy People 2020 Goals. The Centers for Disease Control and Prevention have recommendations on pneumococcal vaccination for adults 65+. It is recommended that adults 65+ be vaccinated with two different pneumococcal vaccines to help protect themselves against pneumococcal disease. Prevnar 13 is recommended for both pneumococcal vaccine-naïve and PPSV23- previously vaccinated adults aged 65+. Prior receipt of PPSV23 within 1 year results in

5 diminished immune responses to Prevnar 13 compared to PPSV23-naïve individuals. IMPORTANT SAFETY INFORMATION Severe allergic reaction (eg, anaphylaxis) to any component of Prevnar 13 or any diphtheria toxoid containing vaccine is a contraindication Immunocompromised individuals or individuals with impaired immune responsiveness due to the use of immunosuppressive therapy may have reduced antibody response In adults, the most commonly reported solicited adverse reactions were pain, redness, and swelling at the injection site, limitation of arm movement, fatigue, headache, muscle pain, joint pain, decreased appetite, vomiting, fever, chills, and rash

Measure #111 (NQF 0043): Pneumococcal Vaccination Status for Older Adults National Quality Strategy Domain: Community/Population Health

Measure #111 (NQF 0043): Pneumococcal Vaccination Status for Older Adults National Quality Strategy Domain: Community/Population Health 2017 OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS ONLY MEASURE TYPE: Process