As an ACO executive / Health System executive, if you currently have a Healthcare Analytics / Pop Health Platform vendor, most likely you are using their Quality Analytics / Reporting application. In this article, I will suggest some effective means of closing Quality Gaps using such applications. As we know, the Quality Composite Score, alone, has probably the biggest impact on your Savings / Losses. If you employ the second and third ‘Computation Scenarios’ discussed below, you will get early insights and valuable retrospective insights that will help you achieve better Quality overall score.
The most common Computation Scenario you are most likely already employing is computing a set of measures (e.g. ACO QPP measures) for a given year (e.g. reporting year 2017) with the same year definitions (2017 definitions) for a selected population (Preliminary prospective assigned population) while the performance / reporting year is in progress. The key to effectively use this Scenario is to keep the data most up to date. With this Scenario, you can identify Quality gaps in care, but sometimes there are some operational reasons why we can not just rely only upon it.
Think about this second Computation Scenario. You may want to compute a set of measures against a previous reporting period (quarter or year) because certain measures use data that are inherently delayed (e.g. Claims data). So, for example, you may want to compute 2017 ACO Claims based measures with current year’s definitions (e.g. year 2017) against previous year’s data (2016 year), to get a full year’s perspective. You can also use the same technique against previous Quarter data and extrapolate your numbers for the year once you have data ready. Computing current definitions against previous data will enable ACOs and Health Systems to make some important strategic decisions. Even though they don’t have to submit Claims bases measures, they can gain insights using these.
The third Computation Scenario that I am going to write here will be very useful around the start of any new reporting year (e.g. the first quarter of 2017 reporting year). Every year, as we know, the measure definitions could change, at least slightly, and the QI Analytics vendors probably need time to catch up with the definitions as the specifications may not have been available well in advance. It usually takes some time to ‘Go Live’ with new Measure definitions in a given year. However, ACOs lose valuable time if they simply wait for the first 3 to 6 months or sometimes more for QI measures to be Live. So, at the beginning of a year, you may want to compute a set of measures (e.g. ACO 2017 QPP measures) using previous year’s definitions (2016 definitions – although they may not be exactly the same, they are damn close to 2017 definitions) against new year data to have early insights and close Quality gaps. Eventually, when 2017 definitions are Live, just fall back to the most common Scenario to close further gaps and report accurately. Please note that this Computation Scenario is the mirror image of the second Computation Scenario mentioned above, in terms of Measure version vs. Reporting year.
Also note that all these Scenarios must be / could be executed against selected cohorts based on various different criteria like disease conditions, attributed providers, prior-year performance and assigned populations per contract etc.
Simple, but effective computations! Feel free to connect to me and message me if you would like any help in your Pop Health needs.