Transitional Care and ACO Quality Measures

Transitional Care and ACO Quality Measures

A recent OIG report shows that ACOs are able to reduce Medicare spending and improve quality but that key areas for improvement still exist.

The report, titled “Medicare Shared Savings Program Accountable Care Organizations Have Shown Potential for Reducing Spending and Improving Quality” analyzed data on the 33 quality measures from the past three years to conclude that most Shared Savings Program ACOs were successful in reducing spending while also improving quality of care. Data for the ACO quality measures comes from patient surveys, Medicare claims, and clinical data.

There are however some quality measures lagging that can be addressed with centralized and standardized transitional care programs. These low-performance quality measures include:

  • Patients’ rating on how well doctors communicate (0.5% worsening)
  • Percent of patients readmitted to a hospital within 30 days (0.3% improvement)
  • Patients’ rating on doctors’ promotion and education about patients’ health (1.7% improvement)
  • Rate of hospital admissions for patients with chronic obstructive pulmonary disease or asthma in older adults (3.1% improvement)
  • Percent of patients screened for high blood pressure and a follow-up plan was created (when appropriate) (13.8% worsening)

A centralized and standardized transitional care program should contain the following key components:

  • A dedicated transitional care software platform for standardization of activity assignment, call scripting and data capture
  • Centralized call center for cost effective and consistent discharge follow up
  • Condition-specific patient and family caregiver education to promote health literacy and awareness of red and yellow flags and appropriate actions if presented

When applied to the quality measures that either worsened or only slightly improved, this transitional care methodology can positively impact these quality measures and further increase quality of care and financial savings.

For example, discharge phone calls to patients on behalf of the provider reinforce the information relayed from the physician through the discharge instructions and improve scores related to clinical communication and education. The same discharge phone calls to patients can strengthen the patient’s understand of yellow flags and red flags that indicate a decline in health, promoting early detection of decline and reductions in hospital readmissions. In addition, transitional care software provides the administrative backbone to manage multiple patients consistently and proactively saving precious nursing assets for crucial clinical tasks.

While much of the heavy lifting has been done, even incremental improvement in quality is significant because an ACO’s performance on the quality measures determines the portion of savings it may receive. Higher quality scores, such as 90 or above on a scale of 100, mean that an ACO performed well on the majority of the individual measures and that the ACO will receive a higher proportion of the savings. Investments in transitional care initiatives can lead to significant improvements in the savings, while also significantly reducing total Medicare spend.

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