Stakeholders Back Standard ACO Measures for Commercial Orgs in CA

December 28, 2017 - The Integrated Healthcare Association (IHA) and Pacific Business Group on Health (PBGH) recently embarked on a joint mission to standardize accountable care organization (ACO) measures for quality and cost performance and benchmarking for commercial organizations in California.

“California continues to lead innovative healthcare delivery and payment approaches, including ACOs that encourage providers to integrate and coordinate patient care,” Jeff Rideout, MD, IHA President and CEO, stated in a press release. “At the same time, healthcare performance measures have proliferated nationally, increasing demands on providers and potentially working at cross purposes to advancing higher-value care.”

The California-based non-profit healthcare groups aim to create standard ACO benchmarking practices that can help consumers, health plans, and providers deliver high-value care without the additional administrative burden of reporting on different quality and cost performance measure sets for each payer.

Only about 5 percent of quality measures used by commercial health plans were included in more than half of the plans analyzed in a 2013 Health Affairs study. And just 17 of 301 Physician Quality Reporting System and five Medicare Shared Savings Program measures were the same as measures commonly used by commercial plans.

Another study also uncovered that 48 state and regional healthcare programs, commercial health plans, and regional collaboratives used a total of 509 quality measures. Only 20 percent were used by more than one program.

The burden of quality measure misalignment across payers may grow for ACOs. The number of ACO contracts increased by 166 contracts between 2016 and 2017, with the growth primarily stemming from existing organizations entering additional accountable care contracts.

“We currently collect data for literally hundreds of distinct performance measures that vary from health plan contract to health plan contract,” said Mark Schafer, MD, the CEO of MemorialCare Medical Foundation, a supporter of the IHA-PBGH mission. “Creating a single, comprehensive set of performance measures will help us focus on what matters most—improving patient care.”

IHA and PBGH plan to launch standard ACO measures and benchmarking in 2018, with 18 clinical quality, hospital utilization, and cost measure sets for care delivered in 2017. The measures include recommended cancer screenings, comprehensive diabetes care, emergency department visits, and total cost of care per attributed patient.

The industry groups intend to add developmental measures in the following year, bringing the total to 35 performance measures for commercial ACOs in California.

The most recent effort to standardize ACO measures and benchmarking will build on IHA’s previous performance measure and benchmarking programs for the state’s provider organizations in commercial and Medicare Advantage health plan provider networks.

While ACO providers will benefit from standard ACO measures and benchmarking practices, the initiative will also help other stakeholders identify high-quality, cost-effective providers and practices, IHA and PBGH explained.

“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,” explained David Lansky, PhD, PBGH CEO. “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.”

IHA and PBGH anticipate the standard ACO measures and benchmarking in California to influence the development of a national model. To promote a similar national model, IHA will also partner with the National Quality Forum (NQF).

“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 Shantanu Agrawal, MD, NQF President and CEO.

ACO providers, health plans, and other stakeholders have welcomed the initiative. California’s four largest commercial health plans – Aetna, Anthem Blue Cross, Blue Shield of California, and Health Net – endorsed the IHA and PBGH mission along with the state’s leading healthcare purchasers – Boeing, CaIPERS, Covered California, and Google – and ACOs, 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.

Industry groups CAPG and Catalyst for Payment Reform also voiced their support for common ACO measure sets and benchmarking.