Medicare Shared Savings Program
The HHC ACO is participating in the Medicare Shared Savings Program (MSSP) to encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery. The HHC ACO works to meet and exceed the quality of care performance standard defined by CMS and determined using nationally recognized measures in four key areas:
- Patient/caregiver experience
- Care coordination/patient safety
- Preventive health
- At-risk population (diabetes, depression, hypertension, ischemic vascular disease, heart failure and coronary artery disease)
Amount of Shared Savings / Losses
- Performance Year 1: $3,639,766
- Performance Year 2: $2,644,605
- Performance Year 3: $6,052,364
How Shared Savings Are Distributed
i. Up to 100% retained by HHC ACO as an offset to costs incurred in developing and maintaining the ACO’s infrastructure and operations.
ii. If MSSP shared savings payments exceed the amounts described in (i), the remainder is divided 50% to NYC Health + Hospitals and 50% to other participants for reinvestment in meeting the goals of HHC ACO and incentivizing population health management.
Quality Performance Results
2015 Reporting Period | |||
Measure Number | Measure Name | ACO Performance Rate | Mean performance rate (SSP-ACOs) |
ACO #1 | CAHPS: Getting Timely Care, Appointments, and Information | 70.68 | 80.61 |
ACO #2 | CAHPS: How Well Your Providers Communicate | 86.53 | 92.65 |
ACO #3 | CAHPS: Patients’ Rating of Provider | 86.94 | 91.94 |
ACO #4 | CAHPS: Access to Specialists | 69.38 | 83.61 |
ACO #5 | CAHPS: Health Promotion and Education | 57.45 | 59.06 |
ACO #6 | CAHPS: Shared Decision Making | 74.00 | 75.17 |
ACO #7 | CAHPS: Health Status/Functional Status | 72.75 | 72.30 |
ACO #34 | CAHPS: Stewardship of Patient Resources | 22.14 | 26.87 |
ACO #8 | Risk Standardized, All Condition Readmission | 15.83 | 14.86 |
ACO #35 | Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) | 18.74 | 18.07 |
ACO #36 | All-Cause Unplanned Admissions for Patients with Diabetes | 58.33 | 54.60 |
ACO #37 | All-Cause Unplanned Admissions for Patients with Heart Failure | 107.12 | 76.96 |
ACO #38 | All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions | 81.31 | 62.92 |
ACO #9 | Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) | 1.88 | 1.11 |
ACO #10 | Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8) | 1.59 | 1.04 |
ACO #11 | Percent of PCPs who Successfully Meet Meaningful Use Requirements | 100.00% | 80.14% |
ACO #39 | Documentation of Current Medications in the Medical Record | 65.11% | 84.07% |
ACO #13 | Falls: Screening for Future Fall Risk | 50.36% | 56.46% |
ACO #14 | Preventative Care and Screening Influenza Immunization | 72.93% | 62.03% |
ACO #15 | Pneumonia Vaccination Status for Older Adults | 85.09% | 63.73% |
ACO #16 | Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up | 64.34% | 71.15% |
ACO #17 | Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 93.09% | 90.16% |
ACO #18 | Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan | 91.15% | 45.25% |
ACO #19 | Colorectal Cancer Screening | 65.33% | 60.06% |
ACO #20 | Breast Cancer Screening | 81.85% | 65.67% |
ACO #21 | Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented | 74.06% | 70.04% |
ACO #40 | Depression Remission at Twelve Months | 9.43% | 6.11% |
ACO #27 | Diabetes Mellitus: Hemoglobin A1c Poor Control | 18.77% | 20.38% |
ACO #41 | Diabetes: Eye Exam* | 59.39% | 41.05% |
ACO #28 | Hypertension: Controlling High Blood Pressure | 62.36% | 69.62% |
ACO #30 | Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic | 91.25% | 83.82% |
ACO #31 | Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) | 98.86% | 87.22% |
ACO #33 | Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy – for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) | 91.47% | 77.73% |
Note: CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.
*= Measure required beginning Reporting Year 2015.
N/A= Reporting on the depression remission measure is not required for 2015, as indicated by N/A
2012 Reporting Period | 2013 Reporting Period | 2014 Reporting Period | |||||
Measure number | Performance measure | ACO performance Rate | Mean performance rate for all ACOs | ACO performance Rate | Mean performance rate for all ACOs | ACO performance Rate | Mean performance rate for all ACOs |
ACO #1 | Getting Timely Care, Appointments, and Information | Not in Operations | 70.19 | 81.48 | 63.46 | 80.13 | |
ACO #2 | How Well Your Doctors Communicate | Not in Operations | 89.16 | 92.96 | 89.22 | 92.39 | |
ACO #3 | Patients’ Rating of Doctor | Not in Operations | 89.18 | 92.06 | 90.16 | 91.58 | |
ACO #4 | Access to Specialists | Not in Operations | 75.92 | 85.12 | 76.73 | 83.97 | |
ACO #5 | Health Promotion and Education | Not in Operations | 63.24 | 58.38 | 64.82 | 58.29 | |
ACO #6 | Shared Decision Making | Not in Operations | 70.62 | 74.53 | 70.92 | 74.60 | |
ACO #7 | Health Status / Functional Status | Not in Operations | 70.35 | 71.12 | 71.13 | 71.10 | |
ACO #8 | Risk Standardized, All Condition Readmissions | Not in Operations | 16.32 | 14.90 | 15.64 | 15.15 | |
ACO #9 | ASC Admissions: COPD or Asthma in Older Adults | Not in Operations | 3.10 | 1.17 | 2.41 | 1.08 | |
ACO #10 | ASC Admission: Heart Failure | Not in Operations | 2.06 | 1.20 | 1.86 | 1.19 | |
ACO #11 | Percent of PCPs who Qualified for EHR Incentive Payment | Not in Operations | 2.86 | 66.21 | 16.42 | 76.71 | |
ACO #12 | Medication Reconciliation | Not in Operations | 93.07 | 73.56 | 95.73 | 82.61 | |
ACO #13 | Falls: Screening for Fall Risk | Not in Operations | 49.56 | 39.57 | 45.96 | 45.60 | |
ACO #14 | Influenza Immunization | Not in Operations | 75.29 | 56.93 | 76.87 | 57.51 | |
ACO #15 | Pneumococcal Vaccination | Not in Operations | 79.52 | 54.76 | 79.84 | 55.03 | |
ACO #16 | Adult Weight Screening and Follow-up | Not in Operations | 59.34 | 61.61 | 64.22 | 66.75 | |
ACO #17 | Tobacco Use Assessment and Cessation Intervention | Not in Operations | 88.40 | 84.01 | 87.32 | 86.79 | |
ACO #18 | Depression Screening | Not in Operations | 86.57 | 31.19 | 88.87 | 39.27 | |
ACO #19 | Colorectal Cancer Screening | Not in Operations | 75.57 | 59.30 | 70.96 | 56.14 | |
ACO #20 | Mammography Screening | Not in Operations | 76.41 | 62.05 | 78.46 | 61.41 | |
ACO #21 | Proportion of Adults who had blood pressure screened in past 2 years | Not in Operations | 67.04 | 74.25 | 78.46 | 60.24 | |
ACO #22 | Hemoglobin A1c Control (HbA1c) (<8 percent) | Not in Operations | 72.81 | N/A | 69.21 | N/A | |
ACO #23 | Low Density Lipoprotein (LDL) (<100 mg/DL) | Not in Operations | 63.12 | N/A | N/A | N/A | |
ACO #24 | Blood Pressure (BP) <140/90 | Not in Operations | 67.87 | N/A | 69.87 | N/A | |
ACO #25 | Tobacco Non Use | Not in Operations | 58.37 | N/A | 80.79 | N/A | |
ACO #26 | Aspirin Use | Not in Operations | 87.13 | N/A | 90.28 | N/A | |
ACO #27 | Percent of beneficiaries with diabetes whose HbA1c in poor control (>9 percent) | Not in Operations | 14.26 | 22.11 | 16.39 | 20.35 | |
ACO #28 | Percent of beneficiaries with hypertension whose BP <140/90 | Not in Operations | 68.34 | 67.79 | 63.71 | 68.02 | |
ACO #29 | Percent of beneficiaries with IVD with complete lipid profile and LDL control <100mg/dl | Not in Operations | 68.77 | 55.44 | N/A | N/A | |
ACO #30 | Percent of beneficiaries with IVD who use Aspirin or other antithrombotic | Not in Operations | 87.38 | 76.35 | 93.46 | 80.79 | |
ACO #31 | Beta-Blocker Therapy for LVSD | Not in Operations | 93.75 | 79.82 | 89.62 | 82.71 | |
ACO #32 | Drug Therapy for Lowering LDL Cholesterol | Not in Operations | 92.86 | N/A | N/A | N/A | |
ACO #33 | ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes and/or LVSD | Not in Operations | 88.59 | N/A | 91.62 | N/A |
Note: ASC = ambulatory sensitive conditions, COPD = chronic obstructive pulmonary disease, PCP = primary care physician, EHR = electronic health record, IVD = ischemic vascular disease, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.
For more information on how to interpret scores on the above quality performance measures, see http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-QM-Benchmarks.pdf.
For general questions or additional information regarding Accountable Care Organizations, please visit: www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227 (TTY users should call 1-877-486-2048)).