Employers, Health Plans and Providers Endorse Initiative to Standardize Performance Measures for Commercial Accountable Care Organizations (ACOs) in California
OAKLAND, CALIF.—In an effort to collect more meaningful quality and cost information and reduce burden on clinicians, leading California health care purchasers, plans and providers today endorsed an initiative to standardize ACO performance measurement and benchmarking that could serve as a national model, according to the Integrated Healthcare Association (IHA) and Pacific Business Group on Health (PBGH).
The goal of the IHA-PBGH partnership is to develop and implement a standard quality and cost performance measure set for commercial ACOs that meets the needs of participating purchasers, health plans and providers to improve care while advancing national efforts for coordinated, meaningful performance measurement that promotes high-quality, affordable, patient-centered care—or high-value care.
Participants and supporters include four of the state’s largest commercial health plans—Aetna, Anthem Blue Cross, Blue Shield of California, and Health Net—leading purchasers—Boeing, CalPERS, Covered California, and Google—and prominent providers participating in ACOs across the state, including Cedars-Sinai, Brown & Toland Physicians, HealthCare Partners, Hill Physicians, John Muir Health, MemorialCare Medical Foundation, Monarch HealthCare - Part of OptumCare, NAMM California - Part of OptumCare, Providence Health and Services, Sharp Rees-Stealy Medical Group, Stanford Health Care, Sutter Health, and UC Davis Health.
To improve quality and help keep care affordable, purchasers and payers increasingly are turning to innovative payment arrangements, such as ACOs, which typically encourage physicians, hospitals and other providers to work together and be accountable for both the quality and cost of care for a defined group of health plan enrollees. The effort builds on IHA’s other successful performance measurement and benchmarking programs for California physician organizations participating in commercial and Medicare Advantage health plan provider networks.
“California continues to lead innovative health care delivery and payment approaches, including ACOs that encourage providers to integrate and coordinate patient care,” said IHA President and CEO Jeff Rideout, M.D. “At the same time, health care performance measures have proliferated nationally, increasing demands on providers and potentially working at cross purposes to advancing higher-value care.”
Similarly, Jeff Bailet, M.D., executive vice president at Blue Shield of California, said, “In addition to reducing reporting burdens on providers, standardizing performance measurement across health plans will make the results more meaningful to clinicians and help them focus on the most important areas for improvement to deliver high-quality, affordable care for their patients.”
Leading health care groups, such as CAPG and Catalyst for Payment Reform, also endorsed the initiative, which includes a common ACO measure set and benchmarking process. As additional organizations join, an updated list of participating purchasers, health plans and provider organizations will be available online, along with more detailed information about the ACO initiative and measure set.
“Given the high and variable costs and uneven quality of care across California and the nation, purchasers and payers increasingly are seeking to identify physicians, hospitals and other providers that deliver high-quality care at an affordable price through ACOs,” said PBGH CEO David Lansky, Ph.D. “With upwards of 20 percent of consumers now using ACOs, we need a common yardstick to measure and benchmark ACO performance if we are going to improve quality and keep care affordable.”
The ACO measurement and benchmarking initiative will launch in 2018 and include 18 clinical quality, hospital utilization and cost measures for care provided in 2017, ranging from recommended cancer screenings to comprehensive diabetes care to emergency department visits to the total cost of care per enrollee. In the following years, additional developmental measures will be added and tested, bringing the total to 35 performance measures.
ACO providers welcome the initiative, especially the focus on making performance measurement more meaningful and less burdensome for providers. “We currently collect data for literally hundreds of distinct performance measures that vary from health plan contract to health plan contract,” said MemorialCare Medical Foundation CEO Mark Schafer, M.D. “Creating a single, comprehensive set of performance measures will help us focus on what matters most—improving patient care.”
Consistent commercial ACO performance measures and statewide and national benchmarks can help health plans, physician organizations, and purchasers target performance improvement activities that advance the goal of high-quality, affordable, patient-centered care. To that end, IHA and the National Quality Forum (NQF) are working together to develop a benchmarking framework for California ACOs that could serve as a national model. NQF is a national health care improvement organization that sets standards for healthcare quality and works to drive improvement across health care settings.
Along with working to establish national ACO benchmarks, IHA and NQF will collaborate on developing next-generation ACO performance measures, including patient-reported outcomes, that capture what matters most to patients and improving their care.
“Developing a national benchmarking standard for ACOs and next-generation ACO performance measures will be critical to ensure meaningful measurement that minimizes reporting burdens, drives improved performance, and results in better, safer care for patients,” said NQF President and CEO Shantanu Agrawal, M.D.
Based in Oakland, Calif., the nonprofit Integrated Healthcare Association (IHA) convenes diverse stakeholders—including physicians, hospitals and health systems, purchasers, and health plans—committed to high-value, integrated care that improves quality and affordability for patients across California and the nation. For more information, visit www.iha.org.