Latest CMS performance results show average performance

Integrated delivery networks (IDN) have become increasingly powerful in recent years, as consolidation within the healthcare industry has resulted in fewer regional players that have a greater influence on their respective markets. According to Decision Resources Group’s IDN Analyzer, an IDN is an organized system of tightly aligned healthcare providers and facilities that delivers a full range of coordinated clinical services across inpatient and outpatient settings in a distinct geographic region. IDN characteristics can include shared clinical guidelines, a common technology platform, and the ability to jointly negotiate with payers on contracts that may involve financial risk for quality and patient outcomes. Simply put, IDNs are their own healthcare ecosystems.

IDNs were among the earliest adopters of value-based care and Medicare ACO programs, which included the Pioneer ACO program and the Medicare Shared Savings Program. IDNs also have opted to participate in the Next Generation ACO program, which is approaching the end of its second year. The Centers for Medicare & Medicaid Services recently released Medicare ACO results for Performance Year 2016, which encompassed the MSSP ACO results, the final Pioneer ACO results, and the initial Next Generation ACO results.

Medicare ACO performance results are based on specific quality metrics that are grouped into different domains. However, on closer examination, the various quality measures can be grouped and analyzed by therapeutic area, including chronic obstructive pulmonary disorder and asthma, cardiovascular disease and heart failure, diabetes, depression, and vaccinations and preventive screenings. It is important to look at both current ACO results and historical data to determine in which therapeutic area-specific quality measures IDNs have performed well and in which areas IDNs have performed poorly. This can also give an indication of therapeutic areas in which IDNs have improved or regressed over time.

The 2016 Medicare ACO results show there were some changes in therapeutic area performance for IDNs in the most recent performance year. For the most part, IDNs turned in an average performance. That includes vaccinations and preventive screenings, measures in which IDNs had previously been among the worst performers. IDNs were among the top performers in several readmissions measures. For example, performance was strong for Risk-Standardized All Condition Readmissions and Skilled Nursing Facility 30-Day All-Cause Readmissions, indicating that IDNs managed to reduce readmissions regardless of condition or issue.

However, examination of admissions and readmissions for specific conditions indicates that IDNs are struggling to manage these populations. IDNs were among the worst performers in admissions and readmissions for COPD and asthma, heart failure, and diabetes. In previous performance years, IDNs were strong performers in admissions and readmissions for COPD and asthma.

In general, these healthcare entities performed poorly in other quality measures pertaining to heart failure and diabetes. Performance in the ACE Inhibitor or ARB Therapy for Patients with Diabetes and CAD and/or LVSD was also quite poor, signaling therapeutic areas on which IDNs may wish to focus in the coming years. The diabetes measures in which IDNs were among the worst performers included Diabetes-Eye Exam and the Diabetes Composite score, which considered both the Hemoglobin A1c in Poor Control and Diabetes-Eye Exam measures. This is the second performance year for reporting Diabetes-Eye Exam.

Though it is important to look at the overall performance within the context of Medicare ACOs and their financial performance, it is also important to break out performance by therapeutic area. This can indicate areas in which IDNs have succeeded in improving care or areas in which IDNs should focus their efforts. It is also important to note that these measures can change from year to year, depending on therapeutic areas CMS believes are of importance to improve care. Expect IDNs to continually adjust their strategies to maintain and improve care for patients.

Follow Sarah Wilson on Twitter @SarahWilsonDRG.

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