When a provider knocks on the exam room door, the patient waiting inside is anticipating high quality care delivered by a compassionate clinical expert. Of course, high quality care begins well before the provider enters the room. It encompasses a broad range of activities and services performed by a team of dedicated professionals. It relies on population health teams doing pro-active outreach to patients, medical assistants doing sophisticated pre-visit planning and patient service representatives communicating effectively with patients. Providing high quality care is a continuous process that every care team member contributes to every day.
Measuring quality of care is a central component of the ACO’s work. 2019 marks the fifth anniversary of a key innovation in this area, the ACO’s Quality Heat Map. The heat map tracks each ACO region’s monthly progress towards goal achievement for the 10 highest-impact quality measures. For providers and teams, it eliminates the burden of tracking dozens of quality measures across multiple value-based contracts and helps them focus improvement efforts where they’ll have the greatest potential impact on patient outcomes. For the ACO, the heat map is an accessible communication tool that helps to keep quality priorities in sharp focus for its participants.
During 2019, the ACO’s network of providers achieved a perfect quality score in Medicare’s Merit-based Incentive Payment System (MIPS) and met the goals set for 6 out of 10 heat map measures. Overall, breast cancer screening rates improved 3.2 percentage points, diabetic eye exam rates increased 2 percentage points, colon cancer screening rates increased 1.9 percentage points and HbA1c levels improved 1.1 percentage points.
To fully appreciate these annual improvements, it’s useful to look at the longer range trend that has developed over several years. Since 2017, when the breast cancer screening measure was established, the screening rate has increased 10 percentage points. Since 2015, the diabetic eye exam rate has increased 12 percentage points and the colon cancer screening rate has increased 16 percentage points.
Because of these improvements in quality over the past three years alone, 32 fewer people will die this year from a hypertension-related cardiovascular event, 16 fewer will die this year from colon cancer and two fewer people will die from breast cancer*.
Looking at the percentage of patients with diabetes with HbA1c values over 9, we see a 4 percentage point decrease since 2015 (lower is better for this measure). HbA1c is a marker of glycemic control and improved performance on this measure can mean better clinical outcomes. A recent peer-reviewed article shows that it is associated with a 50 to 76 percent reduction in the progression of microvascular complications, like neuropathy, retinopathy and diabetic kidney disease.
Tracking improvements in quality is important, but the ACO does not stop there. We also help providers make these improvements. The ACO’s Performance Team offers support through practice visits from improvement advisors and educational resources like a series of clinical best practice frameworks.
*Calculations based on MHACO denominators, improvement rates, and the below articles
1. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Sundström, Johan, Arima, Hisatomi, et al, Annals of Internal Medicine (volume 162, issue 3, pages 184-191, 2/3/2015
2. Comparing Risks and Benefits of Colorectal Cancer Screening in Elderly Patients; Cynthia W. Kolow, GASTROENTEROLOGY 2005;129:1163-1170
3. US Preventive Services Task Force. Screening for breast cancer. US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-726