Reimbursement rates for an Accountable Care Organization (ACO) are based on the quality composite score from the Physician Quality Reporting System Group Practice Reporting Option, examining best practice preventative care and primary care measures. As a result, ACO participants may receive payment adjustments based on their quality composite performance.
U.S. Medical Management (USMM), a leading provider of home-based primary care services for complex patient populations and managed care clients, also operates a multi-state Medicare Shared Savings Program ACO serving over 23,000 complex or fragile Medicare patients. USMM needed to support its providers in meeting their patients’ necessities, while also ensuring they were providing and documenting appropriate best practice preventative and primary care ACO measures.
USMM turned to its analytics platform and analytics applications, implementing the Community Care Advanced Application to aid its efforts. The analytics platform integrates data from the organization’s EMR, billing system, and external claims data, bringing cross-organizational data into focus and delivering specific, actionable interventions needed to improve performance.
After implementing Community Care, USMM achieved a 90th percentile performance for:
- Tobacco screening and cessation plan.
- Clinical depression screening and follow-up plan.
The organization also earned an 80th percentile performance for:
- Influenza immunization.
- High blood pressure screening and follow-up plan.
- Screening for future fall risk.