Accountable Care and the end of Fee-for-Service?

Link: Inside HealthPolicy: Family Medicine Initiative Releases Goals For Transforming Primary Care


Family Medicine for America’s Health (FMAHealth), an initiative sponsored by several primary care associations, released a set of six goals for transforming the U.S. primary care system that includes working with both private and public payers to ultimately end fee-for-service pay.

FMAHealth seeks to “adopt a uniform and simplified model of comprehensive payment that encourages front-end investment in expanded practice infrastructure and technology, rewards Triple Aim goals (better care, better health and lower costs) and supports broad, team-based care.”i

It is widely known that our country spends more on healthcare for less quality than other nations. The Commonwealth Fund sponsored an analysis of cross-national health systems based on Organization for Economic for Co-operative Development health data to place the performance of the U.S. health system in an international context.ii  It shows significant spending by the US in all three categories of 1) Out-of-pocket spending, 2) private spending and 3) public spending.


In the report The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations, it reports “the U.S. has fewer hospital beds and physicians, and sees fewer hospital and physician visits, than in most other countries. Prescription drug utilization, prices, and spending all appear to be highest in the U.S., as does the supply, utilization, and price of diagnostic imaging. U.S. performance on a limited set of quality measures is variable, ranking highly on five-year cancer survival, middling on in-hospital case-specific mortality, and poorly on hospital admissions for chronic conditions and amputations due to diabetes.”ii  

If the U.S has fewer beds, sees fewer hospital and physician visits, what is the source of our per Capita spending? Findings indicate that although healthcare spending is significantly higher than other countries, we are not delivering quality results. We had the highest rates of hospital admissions for the five major chronic conditions and the greatest number of lower-extremity amputations due to diabetes. Is it possible that Accountable Care Organizations and the goals of the Triple Aim to provide better care at lower cost will shift the cost curve down?  CMS projects health spending to grow at an average rate of 5.8 percent from 2012-2022;iii however, in a press release dated 8/25/2015, CMS reported that “20 ACOs in the Pioneer ACO Model and 333 Medicare Shared Shavings Program ACOs generated more than $ 411 million in total savings in 2014, which includes all ACOs’ savings and losses. At the same time, 97 ACOs qualified for shared savings payments of more than $ 422 million by meeting quality standards and their savings threshold. The results also showed that ACOs with more experience in the program tended to perform better over time.”iv

“With chronic disease on the rise amidst an aging demographic and accounting for ever more health care spending, more effective treatment and management in primary care settings, and Accountable Care Organizations, may have the potential to simultaneously improve patient care while preventing the unnecessary use of scarce and expensive resources.v 


For more information on Accountable Care tools and regulations please visit the ACO Survival Guide Website or sign up for the FREE ACO Newsletter.


i H. J. Jiang, C. A. Russo, and M. L. Barrett, Nationwide Frequency and Costs of Potentially Preventable Hospitalizations, 2006, Healthcare Cost and Utilization Project Statistical Brief #72 (Rockville, Md.: Agency for Healthcare Research and Quality, April 2009).

ii Squires, David. “The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations.” The Commonwealth Fund. 1 July 2011. Web. 11 Sept. 2015. Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf. 

iii  Ibid.

iv  “National Health Expenditure Projections 2012-2022 Forecast Summary.” Centers for Medicare & Medicaid Services. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. Web. 11 Sept. 2015. 


Healthcare & Technology

Accountable Care Best Practices?

FolderFile_BlueLink: ACO Best Practices For Shared Savings can be downloaded from Caradigm’s website

In a recent article, Health Data Management provided insight into Accountable Care Organization best practices that are emerging, based on a white paper written by Caradigm. Caradigm is a population health company dedicated to helping organizations improve care, reduce costs and manage risk.

Some of the real-life examples of successful ACOs that were provided in this white paper include practices that:

  • Maintain full data transparency,
  • Provide strong care management,
  • Have the ability for aggregation of clinical and claims data,
  • Provide better managed care transitions,
  • Maintain a reporting repository with data collection from aggregate sources, and 
  • Proactive management of chronic conditions.



For more information on Accountable Care tools and regulations please visit the ACO Survival Guide Website or sign up for the FREE ACO Newsletter.


Healthcare & Technology


Batman Red Son Figure Has Fuzzy Russian Hat Ears

All I know about the Russian culture I learned watching TV and movies. What that in-depth study tells me is that they all eat caviar, drink copious amounts of vodka, and wear hats with furry parts on the forehead. With that in mind I will assume that this Batman Red Son premium format figure that is coming soon to Sideshowtoy has a different sort of utility belt.

batman-redzoom in

This Batman has that same fuzzy hat complete with pointy bat ears. That can only mean that on his utility belt he has a flask of vodka and some salty fish eggs.

We don’t know much about the figure as of now other than the teaser image you see here. Clearly, it’s some communist spinoff of the caped crusader judging by the hammer and sickle.



Café Makes Keyboard-Shaped Waffles: Sticky Keys

I like waffles, video games, and computers so this is a trifecta for me. Nexon is a company that makes video games and it has a computer museum in South Korea. At that museum is a café that serves up some very cool treats for visitors to snack on.

kb-waffle-1zoom in

One of those cool treats is a waffle that is shaped like a keyboard. It’s complete with powdered sugar, but I don’t see any syrup anywhere on the plate. I guess they don’t want you to have a sticky keyboard. I have to say, these waffles look much cooler than the ones produced by the official Keyboard Waffle Iron. They also make some sort of little mouse shaped pastries as well.

kb-waffle-2 kb-waffle-3 kb-waffle-4 kb-waffle-5 kb-waffle-6 kb-waffle-7

It looks like the works is served with whipped cream, berries, and ice cream to boot. Now I’m hungry.

[via Kotaku]


Accountable Care Quality Measures


Link: What Are The 9 Reasons to Stop Scoring Patient Experience?

The above link is a post from Paul Roemer on quality measurement from the patient’s perspective. Although he brings up a few good points about the timeliness and validity of the CAHPS® Survey, monitoring and measuring the quality of care provided to ACO Beneficiaries is directly correlated to a revenue gain or bust. Of particular interest in Paul’s post is the need to compare your scores, question by question (or measure by measure), against average scores for other health systems.

The ability to analyze your performance against the performance of like entities provides a data-driven, procedural approach for analyzing the delivery process. Clearly, population management relies on data-driven methods to analyze and identify high-risk members and allocate services.

So, prior to developing the ACO Quality Measure Checklist, I took a random sample of ACOs and looked at their performance on the Quality Measure Scores. There was significant variation in the results between ACOs as well as the national mean. Recently I took a random sample of ACOs and looked at their performance on the Quality Measure Scores. There was significant variation in the results between ACOs as well as the national mean. 

You can make your own conclusions…

This first domain of the Patient/Caregiver Experience shows very little variation between ACOs and against the national mean. The quality measures in this domain may easily be implemented by different practitioners.


The domain of Care Coordination and its metrics begin to show some variation with the last three measures. Note the continuity of the selected ACOs for Figure 14 Care Coordination. An interesting occurrence is spot-on performance for ACO Measures 8 through 10. Items 12 and 13 show variation where it might not be expected. Medication Reconciliation and Screening for Fall Risks are two standard activities for new patients, patients admitted to hospitals, and regular screening procedures for primary care. Note the mean performance rate for all ACOs.


Now, in the domain of Preventive Health we see some significant variation that is most likely due to the fact that primary care Physicians have not previously been compensated for preventive health and associated interventions. Influenza and Pneumococcal Vaccinations are standard for individuals ages 65 and over unless contraindicated. Adult weight screening and individuals with Diabetes are another area of interest. Tobacco, colorectal, mammography and blood pressure screening should be a standard practice for primary care. Note the mean performance rate in bold for all ACOs.


And finally, in the domain of the At-Risk Population there is widespread gaps and variation in the process of care for ACO Beneficiaries with chronic conditions. Because regulations state that avoidance of At-Risk populations is cause for termination of an ACO, the population of beneficiaries that qualify for measures 22 through 33 should correlate to the number of beneficiaries with associated diagnoses or comorbid conditions. Note the mean performance rate for all ACOs.


Data Source: “Medicare_Data_to_Calculate_Your_Primary_Service_Areas.” Centers for Medicare and Medicaid. Centers for Medicare and Medicaid, 2012. Web. 14 Feb. 2015.



For more information on Accountable Care tools and regulations please visit the ACO Survival Guide Website or sign up for the FREE ACO Newsletter.


Healthcare & Technology


Back to the Future Funko POP! Delorean Won’t Hit 88 MPH

A few days back, I talked a bit about some cool Vinyl Idols’ Back to the Future action figures with the crazy eyes. At the time, I wished there was a DeLorean to go with them. While it’s not in the same style, Funko now has a DMC-12 to go along with your Back to the Future collection.

btf-deloreanzoom in

The car includes a Marty figure with the trademark Funko POP! beady black eyes. Marty is a standard POP! size at 3.75-inches tall, and can be pulled out of the toy car.

I only wish the wheels could turn on the car. I’d still push it around and would need to work out exactly how to make flaming skid marks on my desk as well. You can grab the set from ThinkGeek for $ 24.99(USD).