ACOs Need Help Hitting Quality Measures – Home Health to the Rescue?

The Centers for Medicare and Medicaid Services (CMS) released this week the first quality and financial performance results for individual Pioneer ACOs. Briefly, first year financial results show some Pioneers slowed spending growth by as much as seven percent, while others had cost increases as much as five percent – definitely a mixed bag on the financial performance side. CMS’s Pioneer program offers financial incentives to reduce health spending and meet quality targets. Pioneer ACOs that slow spending keep some of what they save. Where health spending accelerates, Pioneer ACOs must cover some of the additional cost. The potential for losses began the first year for some; others opted for a one-year delay.

The really interesting information, and opportunity for home health providers, is on the quality side. Let’s look at the data. ACOs are measured against 33 quality goals. The information released this week allows us to compare year-over-year quality measure results.

See for yourself: ACO 1st year quality results and ACO 2nd year quality results.

Here are my quick take-aways from this data:

1. The highest quality performers in the first year have dropped out of the program.

2. Quality measures 12-15 and 18 are core to home health best practices and several others are easily managed by home health providers.

3. Home health providers have a significant opportunity to help ACOs, in both the CMS-managed Pioneer program and elsewhere across the country, significantly elevate quality outcomes.

Also of interest this week is a report from Avelere Consulting that explores the quality and cost issue in greater (and more expert) detail. The Avalere Analysis is appropriately entitled, “No Correlation between Quality and Cost-Effectiveness among Medicare ACOs.” The chart below shows the top five quality measures for the highest scores.

Of even greater interest to home health care providers is the graphic illustration of the bottom-five quality measures for the lowest scoring ACOs:

Leavitt Partners reports that, as of June 2014, there were 626 ACOs in the U.S. Next week, I’ll be attending the Leavitt Partners Annual Partner Summit in UT along with representatives from many of these emerging ACOs. I will be sure to highlight the value proposition and quality improvement opportunities from partnerships with community-based home health care providers.

There’s a clear opportunity for home health to support these models as they understand that they truly can’t manage all care, for all patients, across the continuum.


ByChris HollandOn: 10/23/2014 13:26:07

Very helpful summary of the value home care can bring to ACOs. Home care must sell its value in helping ACOs achieve their business and quality goals – without this, home care agencies are viewed as commodities, all the same. An agency has to differentiate itself to thrive going forward, not just show up as a provider in a geographic area.