It’s safe to say that ACOs groups are not too happy about the MSSP (Medicare Shared Savings Program) Quality reporting overhaul, the need here is of an exceptional Population Health Management Platform. The conflict stems from multiple policy changes on behalf of CMS that lacked adequate input from patient, ACO, and provider communities. This will have a critical impact on how ACO quality will be graded moving forward. The changes are so drastic that NAACOS has even called upon CMS to delay these new reporting requirements for three years.

In this article, we’ll cover some of these issues and see how ACOs and Population Health Management platforms can help. First a definition of what we mean by the Population Health Management platform:

1. A single integrated system that creates a true consolidated patient record and provides Quality, Care and Cost and Utilization Management analytics and workflows. The latest generation of such systems include extensive use of AI to support these capabilities.

1.   Support data extraction and standardization

While the move to electronic reporting and away from manual chart reporting is a step in the right direction, the barriers to data extraction and standardization play a significant role in complying with the new rules. The major issue here is that ACOs have to report on multiple EHRs that can significantly complicate things as CEHRT (Certified Electronic Health Record Technology) requirements do not standardize the capture and reporting of eCQM data elements across vendor systems. A platform that can tailor reliable data extracts across tens of EHRs in addition to standardizing and transforming them for maximum insights can help to reduce this burden on caregiver organizations.

2.   Handling all-payer data

One of the major new requirements on the quality measure data, as it stands now, includes all patients who receive care from a participating ACO. More specifically, ACOs will have to report on 70 percent of patients and not just a sampling of Medicare assigned beneficiaries as was the case when reporting to the GPRO/CMS Web Interface. A platform that uses a data extraction process that extracts data for all patients for all payers and not just Medicare patients can significantly help organizations meet and exceed the mark in this endeavor.

3.   Data validation & Population Health Management

Making sure the data is reliable is a heavily involved process that requires getting many subprocesses right. Not using reliable data during the reporting process can be extremely detrimental to the organization and result in dramatically lowered performance scores. A true Population Health Management platform has an internal infrastructure that can support data validation in multiple ways including:

1. Patient matching
2. Data normalization
3. Data cleaning
4. Deduping

Not having a tool in place to complete these tasks can leave an organization vulnerable to the validation requirements needed to qualify for the maximum amount of savings.

4.   Workflow Automation – Population Health Management Platform

Analyzing quality and reporting on it is one set of challenges but the real work starts when an organization uses that data to try and improve quality. This aspect of care management for quality improvement is often overlooked when selecting Population Health Management tools. This is where AI can play a game changing role, especially if the organization is managing multiple Value Based Care programs in addition to the MSSP ACO. The ability to automate care management processes can reduce workloads by as much as 90%.

New measures are constantly being introduced or modified. That is why NAACOS is pushing CMS to reverse removing the pay-for reporting year for new measures that are critical to letting ACOs evaluate their current operational strategies when significant shifts are made to performance pathways. Assessing the workflow and quality data capture is key to placing in the top percentile of organizations. Automating these processes assures these new changes scale according to what the organization needs.

While it seems that the conversation is far from over, it doesn’t hurt to use the 2021 transition period to at least prepare for the changes that are certainly coming in the next couple years. Providers can do so by turning to a Population Health Management platform that supports data extraction and standardization across EHRs, handles all-payer data, has the tools to properly validate patient data, and helps with workflow automation processes when significant performance pathway changes are made.

Enabling these tools will help ACOs best prepare for the upcoming changes, no matter what lies ahead.

 Contact us to find out how Persivia can help today.