Commonwealth guide outlines strategies to measure care coordination in medical homes

Posted on October 22, 2011 | No Comments
Filed under Health Care Quality and Delivery System Reform, Library, Third Party Resources

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Patient-centered medical home models offer accessible, coordinated, comprehensive care focused on the needs of the patient. One of the most notable attributes of medical homes is the care coordination, which, if executed effectively, results in better health outcomes, reduced waste and duplication, and higher patient satisfaction. Yesterday, the Patient-Centered Primary Care Collaborative, an arm of the Commonwealth Fund, released a guide outlining seven key strategies to help health systems measure care coordination within medical homes. The seven strategies are 1) Work with a broad stakeholder group to reach consensus on measures; 2) Clarify purpose of measurement: quality improvement, accountability, evaluation; 3) Use standardized measures; 4) Incorporate patient feedback in assessing quality of care coordination; 5) Develop a tracking system that facilitates ongoing monitoring of performance; 6) Build and nurture relationships with providers outside of your medical home–the “medical neighborhood”–to facilitate data sharing, monitoring, and improvement; and 7) Use the data to improve care coordination. Share results at the practice and care-team levels.

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Update: Release of Medicare Data for Performance Measurement

February 24, 2012

Health policy experts and lawmakers believe that measuring and publicly reporting information about the performance of physicians, hospitals, and other health care providers is critical to improving health care quality and controlling costs. Advancing health information access and transparency is a goal of the Patient Protection and Affordable Care Act (ACA) ^[1], which includes a number of provisions to incentivize quality measurement and reporting and to enable more informed consumer decision-making. Across the country, community organizations, such as the Alliances participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative, have been demonstrating the power of using private payer and Medicaid medical claims data to measure and publicly report on provider performance. Their work could be further strengthened by access to Medicare claims data because it is the single largest pool of information about how health care is delivered in America. Combining Medicare data with data from other public and private payers such as Medicaid and employer sponsored plans, holds the potential to generate more complete and accurate provider performance measurement information, thereby further empowering consumer engagement and quality improvement.

Hospital Readmissions Reduction Program

November 1, 2011

Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.

Dual-eligible Medicare/Medicaid Beneficiaries

August 10, 2011

According to the Centers for Medicare and Medicaid Services (CMS), in 2008 there were an estimated 9.2 million individuals who were eligible for and enrolled in both the Medicare and Medicaid programs (commonly referred to as “dual eligibles”). Two-thirds of dual eligibles qualify because they are over age 65, while the other third qualify because of a disability. Dual-eligible beneficiaries typically have multiple chronic conditions that require a higher level of care and result in increased spending relative to other Medicare and Medicaid beneficiaries; however, their care is not usually coordinated. Policymakers have expressed concern that the lack of coordination between the two programs results in higher costs and poorer health outcomes than would be achieved if Medicare and Medicaid services were better integrated.

Release of Medicare Data for Performance Measurement

July 6, 2011

GAO report suggests HHS address contractor performance and plan for needed measures

January 30, 2012

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform various activities related to health care quality measurement. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), a nonprofit organization that endorses health care quality measures—that is, recognizes certain ones as national standards. In 2010, the Affordable Care Act (ACA) established additional duties for NQF. This is the second of two reports MIPPA required GAO to submit on NQF’s contract with HHS. In this report—which covers NQF’s performance under the contract from January 14, 2010, through August 31, 2011—GAO examines (1) the status of projects under NQF’s required contract activities and (2) the extent to which HHS used or planned to use the measures it has received from NQF under the contract to meet its quality measurement needs, as of August 2011. GAO interviewed NQF and HHS officials, reviewed relevant laws, and reviewed HHS and NQF documents. GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations. NQF concurred with many of the findings in the report and provided additional context.

International survey finds patients with complex needs often receive poorly coordinated care

November 9, 2011

A Commonwealth Fund international survey of adults living with complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical risk. In all of the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction as compared to those patients without one.

AHIP proposal calls for Medicare/Medicaid integration for dually eligible beneficiaries

October 14, 2011

The current lack of coordination between Medicare and Medicaid creates barriers for dual eligibles to access care. Additionally, although they comprise only 15% of all Medicaid beneficiaries, dual eligibles account for nearly 40% of Medicaid expenditures. America's Health Insurance Plans (AHIP), a national trade association which represents much of the health insurance industry, recently released a proposal to address the serious fiscal and access challenges associated with dual eligibility. AHIP provides a menu of models for Medicare/Medicaid integration, which groups six models into three alternative approaches suited to States with varying readiness for integration. To learn more about dual eligibles, click here.

UnitedHealth's working paper examines rural health care under the ACA

July 31, 2011

"Modernizing Rural Health Care: Coverage, quality, and innovation" documents the health needs of rural populations and how well the health care system currently is and will be able respond to these needs. The paper presents data on rural health care quality, the views of people living in rural areas regarding health care delivery, and what physicians identify as major rural health challenges to overcome. The paper also addresses how Medicaid and health insurance Exchange expansion will affect the rural patient population beginning in 2014.

New Commonwealth report examines health center collaboration

July 21, 2011

A new report published by the Commonwealth Fund examines the complex laws and policies governing clinical integration in community health centers and other community providers. The report, "Assessing and Addressing Legal Barriers to the Clinical Integration of Community Health Centers and Other Community Providers," notes that the Affordable Care Act (ACA) provides $11 billion for community health center expansion, and partnerships involving clinical integration are expeceted to increase. Failure to comply with federal laws related to clinical integration may jeopardize health centers' expansion funding.

CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project

October 24, 2011

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.