In the evolving healthcare of today, the term “Value-Based Care” (VBC) has often been associated with an extensive list of Quality Measures (QMs), occasionally reducing Primary Care Physicians (PCPs) to mere box-checkers. However, a refreshing shift is witnessed with CMS’s introduction of the ACO Reach Model, which aims to alleviate the administrative burdens of VBC programs. Instead, the focus is redirected toward aligning healthcare providers around comprehensive outcomes, intertwining risk with Total Medical Expenditures (TME).

Comprehending The ACO Reach Model

A Leap Towards Simplicity

In a bid for clarity, the model distinguishes itself by significantly reducing the number of QMs. Unlike its predecessors with 33 QMs or MIPS boasting a menu of 200, ACO Reach streamlines the process with a concise set of four quality measures.

A Closer Look at the Four Measures

• Risk-Standardized All-Condition Readmission (ACR)

ACR evaluates the fraction of hospital stays leading to readmissions within 30 days of discharge, providing a snapshot of post-treatment complications. Remarkably, this measure is claims-based, eliminating the need for cumbersome chart chasing.

• All-Cause Unplanned Admission for Patients with Multiple Chronic Conditions (UAMCC)

UAMCC delves into the rate of hospital readmissions for aged Medicare patients with two or more chronic conditions. Unraveling complexities, this claims-based measure adds depth to the evaluation of patient outcomes.

• Timely Follow-Up After Acute Exacerbations of Chronic Conditions (Timely Follow-Up)

Timely Follow-Up assesses whether healthcare providers adhere to clinical guidelines, delivering post-acute care within specified timeframes for patients with specific chronic conditions. These conditions encompass coronary artery disease, hypertension, heart failure, diabetes, asthma, and chronic obstructive pulmonary disease, creating a comprehensive approach to patient care.

• CAHPS® Survey

CAHPS® injects the human touch into quality measurement by employing a standard survey to gauge patients’ experiences. Administered by a CMS-approved vendor in collaboration with the ACO, this survey becomes a pivotal component in understanding the qualitative aspect of healthcare delivery.

Breaking Down the Administrative Barriers

In line with CMS’s, ACO Reach significantly reduces the bureaucratic hurdles that providers often encounter in VBC programs. By embracing a focused set of measures, the program not only simplifies reporting but also ensures a more holistic approach to patient care.

Takeaway

In essence, the ACO Reach Model emerges as a beacon of change in the landscape of quality measurement. By prioritizing clarity and aligning providers with overall outcomes, it heralds a new era where healthcare is measured not just in numbers but in the genuine experiences of patients.

Learn more about it at Persivia.