Accountable Care Organizations, or ACOs, have been a hot topic at continuing medical education provider conferences lately. After all, the ACO healthcare payment and delivery model—created by the Affordable Care Act’s Medicare Shared Savings Program to hit the trifecta of improved overall care quality and population health, better patient care experience, and containing the skyrocketing cost of healthcare in the U.S.—shifts the burden of accountability of care from the payor to the provider, who only gets increased pay for improvements in patient outcomes. This means healthcare providers are going to have to step up their game. And that means education.
So ACOs should welcome CME providers who offer the outcomes-driven, quality-improvement–based interventions they need to hit their goals, right? Maybe they should, but it likely won’t be easy, says Bob Meinzer, senior director of national education strategy with the New Jersey Academy of Family Physicians. MeetingsNet recently caught up with Meinzer, who for the past year has been speaking on the topic to standing-room-only crowds.
Q: How are ACOs different from the last big thing in U.S. healthcare, the patient-centered medical home, and the next-to-last big thing, managed care?
PCMHs are individual primary care practices, or groups of practices—they are components of ACOs, but ACOs are more “medical neighborhoods” that also include hospitals and specialists. Both are different from managed care in that their success relies on improving the patient/caregiver experience, not just the bottom line. With ACOs, it’s the healthcare providers who make the care decisions, not the insurer, and the goal is improved health outcomes, which in turn should drive down costs, especially for patients with chronic care issues like diabetes and COPD.
More on ACOs: For more background on Accountable Care Organizations and their potential when it comes to continuing medical education, see Accountable Care Organizations: An Opportunity for CME
Q: What key things should CME providers who want to work with ACOs know?
First, that they are the next big thing in U.S. healthcare. While they may have been rare a few years ago, virtually every major payor is either involved in, planning, or seriously considering ACOs. Many health plans are actively helping providers, especially integrated systems and primary care physician groups, to form ACOs. As of the beginning of 2014, there were a total of 606 public and private ACOs.
Whether the ACO is set up by Medicare, Medicaid, an insurance company, or a pharmacy (Walgreens is the first to set one up), it is a complex entity. If you don’t understand their quality-improvement measures, you’re not going to be able to speak their language or come up with something to offer that they’ll value.
Q: How can CME providers get started?
Quality data reporting and collection support quality measurement, an important part of the Shared Savings Program. Before an ACO can share in any savings generated, it must demonstrate that it met the quality performance standard for that year. There are also interactions between ACO quality reporting and other CMS initiatives, particularly the Physician Quality Reporting System, or PQRS, and meaningful use.
The first thing to look at is the 33 quality measures, divided into four categories, that ACOs are judged on when it comes to getting paid. The categories are patient/caregiver experience; care coordination and patient safety; preventive health; and at-risk population. Of the 33 measures, the seven measures of patient/caregiver experience are collected via the CAHPS survey, three are calculated via claims, one is calculated from Medicare and Medicaid Electronic Health Record Incentive Program data, and 22 are collected via the ACO Group Practice Reporting Option Web Interface. For more specifics, go to the CMS Web site.
Under the patient/caregiver experience domain, CME providers may not be able to do much about improving a patient’s ability to book an appointment quickly, but when it comes to provider communications and shared decision-making—two of the seven quality measures in that domain—providers can bring a lot to the party. But an ACO won’t be interested if you’re planning to just bring in a speaker. CME providers will have to offer both CME credit and an approach that will improve the patient/caregiver experience.
Where I see opportunities in that domain for CME providers is in patient education, because making the patient an equal partner in their care—especially for those with chronic conditions—is central to both patient-centered medical homes and ACOs. Because it will have to be tailored to each individual patient—it’s not a one-size fits all situation—CME providers can provide resources to help patients understand their roles in treating different disease states. We can provide shared-decision-making tools to make it easier for patients to choose among the treatment options physicians give them. It will be an integral part of CME moving forward to help providers work with the patient to come up with a plan that will be satisfactory for everyone.
In the care-coordination and patient safety domain, a CME provider who can reduce the number of hospital admissions for COPD, asthma, and heart failure is going to get the ACO’s attention. The New Jersey Academy of Family Physicians currently has a pneumococcal vaccination quality-improvement CME program in several patient-centered medical homes, some of which are part of an ACO. This is where outcomes matter, since ACOs are paid based on outcomes. Once we are able to show that by combining QI and CME we can dramatically increase these vaccinations, we hope to expand the program from the patient-centered medical home within the ACO to the entire ACO.
The ACO’s job is population health improvement, which is at the top of the outcomes pyramid, so if you can partner with an ACO on QI and patient education, and show that population health is improved, you will have helped the ACO do its job.
Q: What are some of the other obstacles CME providers may face when trying to work with ACOs?
The main humps you’ll have to get over are getting them to know who you are and why they should work with you, and, if there’s pharmaceutical money involved, why they should be able to trust you to handle that.
You’ll have to find out who, among the typical ACO’s 500 doctors, specialists, and hospital administrators are the people you need to talk with. Half the battle is finding the right person to talk to, and then to build trust. You have to be tenacious. And once you find the right person, you have to speak the language he or she will understand.
But for those who can identify a weakness in an area the ACO is being measured on—the Agency for Healthcare Research and Quality has publicly available data you can use to find those weaknesses—and come up with a plan to strengthen it (reduce COPD hospital admissions, for example), ACOs can in fact be the next big thing for improving healthcare, and for CME.