This alignment has particular value in the management of complex long-term conditions such as chronic kidney disease (CKD) and end-stage renal disease (ESRD), where coordinated care can significantly improve patient outcomes. In order for ACOs to reap the maximum benefits of their arrangement with CMS, it is important to understand how the shared savings model works, the quality measures involved, and the specific benefits for patients with kidney health concerns.
Connecting Quality to Compensation
ACOs with a shared savings agreement operate under a model in which their reimbursement is contingent upon their performance against specified quality measures and their ability to lower the cost of care. In essence, CMS has designed a system whereby financial rewards are based on savings generated for the system, provided these savings do not compromise patient care quality. This model incentivizes ACOs to seek new ways to efficiently improve patient outcomes, while limiting unnecessary expenditures.
When an ACO successfully meets the financial and quality benchmarks set forth by CMS, the organization becomes eligible for payments in the form of a gain share. The specifics of these payments vary from one ACO to another, but the goal for the ACO is to thoughtfully lower costs in a manner that also enhances the quality of care.
Key Quality Measures and Assessment
The standard quality measures that ACOs must achieve cover a broad range of healthcare aspects, focusing on patient/caregiver experience, care coordination, patient safety, preventive health, and clinical care for at-risk populations. These measures include factors like timely access to care, communication effectiveness of doctors, patient ratings of their doctors, and specific outcomes such as unplanned admissions for chronic conditions like diabetes and high blood pressure control. Assessment of these measures is conducted through various methods including patient surveys, claims data, and direct reporting through a CMS web interface.
The Financial Upside
The pursuit of CMS incentives is not merely about compliance; it has a tangible impact on an ACO’s financial health. Naturally, more coordinated care will reduce the ACO’s total cost of care, as they will avoid overspending on unnecessary medications, facility services, inpatient/outpatient services, emergency department utilization, etc. By maintaining a high standard of care and keeping operational costs under control, ACOs can earn gain share payments from CMS. This not only helps in offsetting costs but also boosts the overall financial performance of the ACO.
Optimizing ACO Performance
For ACOs aiming to maximize their incentives, the focus should be on enhancing care coordination. This involves ensuring that patients receive necessary screenings, see the appropriate specialists, and avoid unplanned hospital admissions. Such coordination not only boosts the overall quality of care but also reduces unnecessary healthcare spending.
This is especially important when dealing with CKD populations. Because CKD patients often have multiple comorbidities, like diabetes and hypertension, the ACO’s ability to integrate care across specialties will have a direct impact on the relevant quality measures.
Today, ACOs may turn to third-party population health management organizations to manage these complex populations. Healthmap Solutions offers a unique Kidney Population Health Management program specifically for the CKD/ESRD population, and is designed to help ACOs achieve measurable improvements in all quality metrics while containing costs. The program’s key benefits include:
- Reducing avoidable emergency department visits and unplanned hospitalizations;
- Improving medication management;
- Identifying and helping to close care gaps;
- Better coding accuracy;
- Providing timely, actionable clinical insights;
- Predicting those at risk for adverse medical events;
- Enhancing patient satisfaction through personal contact and regular updates on their condition and options;
- Improving access to care for socioeconomically disadvantaged patients.
Conclusion
The alignment of financial incentives with quality metrics under the ACO model fosters a healthcare environment that encourages efficiency and patient-centered care. By understanding and strategically responding to these incentives, ACOs can significantly enhance their operational effectiveness and financial stability, all while delivering higher-quality care to their patients living with kidney disease. With support from Healthmap’s Kidney Population Health Management program, ACOs can expect to improve care coordination, lower costs, and improve the quality of life for their kidney patients.
Interested in learning more? Email Healthmap at Sales@HealthmapSolutions.com to learn about our program for ACOs!
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