Accountable Care Organization Quality Explorer Quick Start Guide
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Background HealthLandscape (a division of the American Academy of Family Physicians [AAFP]) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care are pleased to present the Accountable Care Organization (ACO) Quality Explorer. As part of the Affordable Care Act, new models of health care delivery have been developed aimed at improving the quality of care while reducing costs. Accountable Care Organizations (ACOs) are being touted as potential solutions for the inefficiency and fragmentation of the U.S. healthcare system. ACOs are made up of groups of doctors, hospitals, and other health care providers that coordinate care for Medicare beneficiaries. Early results of one of the Medicare ACO programs, the Medicare Shared Savings Program (MSSP), have been promising, with ACOs experiencing improvements in the majority of quality measures while generating cost savings (http://blog.cms.gov/2014/12/22/acos-moving-ahead/). While the overall performance of the MSSP has been positive, questions remain about how ACO performance varies geographically. For example, how are ACOs in the southeast U.S. and Appalachia (areas with higher prevalence of chronic conditions) performing in terms of quality and cost savings compared to ACOs located in other parts of the U.S. To help answer this question, HealthLandscape has the ACO Quality Explorer, which presents data for 211 ACOs taking part in the MSSP. The tool allows users to visualize 33 quality metrics across five domains, which are compared against benchmarks set by the Centers for Medicare and Medicaid (CMS). Users immediately see whether an ACO is above, within range, or below quality benchmarks, designated by green (above), yellow (within range), or red (below) circles displayed on a map. When users click on a specific site, fly-out menus appear that give more detail about the measures that make up each of the five domains, allowing easy comparison of quality measures across ACOs. In addition, the ACO Quality Explorer allows for statistical analyses that enable users to explore the relationships between ACO quality metrics and population health indicators at the county level. To access the ACO Quality Explorer, please visit http:// More information about the data sources are available at: Medicare Shared Savings Program (MSSP) http://www.cms.gov/medicare/medicare-fee-for-service- Payment/sharedsavingsprogram/index.html?redirect=/SharedSavingsProgram 2 P age
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Table of Contents Scoring System..5 Welcome Screen... 6 General Features... 7 Flared Rollovers with Indicators by Domain... 8 Filter by Domain... 9 Filter by Indicator... 10 Filter by Payment Model, Track, or Change in Costs... 11 Adjust Overall Scores/Thresholds... 12 Data Table... 13 Stats... 14 Stats (ACO Predictor)... 15 Stats (Community Predictor)... 16 Printing... 17 Reset Button... 18 4 P age
Scoring System Before getting started, it is important to have a basic understanding of the scoring system that determines the red, yellow, and green colors for the accountable care organizations. Overall Score the overall score is determined by the five domains and its default settings are the following: Site Score Over 75% - Green -> this indicates that 4 or more of the domains are green Site Score 25% - 75% - Yellow -> this indicates that 2 or 3 of the domains are green Site Score Below 25% - Red -> this indicates that 0 or 1 of the domains are green Domain Score Domain is colored green if none of the indicators fall below the 30 th percentile threshold Domain is colored red if at least one of the indicators is at or below the 30 th percentile threshold Indicator Score Indicator is colored green if it is at or above the 90 th percentile threshold Indicator is colored yellow if it falls between the 30 th percentile and 90 th percentile thresholds Indicator is colored red if it is at or below the 30 th percentile threshold For more information about the benchmarks for the ACO quality measures, please visit http://www.cms.gov/medicare/medicare-fee-for-service- Payment/sharedsavingsprogram/Quality_Measures_Standards.html 5 P age
Welcome Screen When you enter the Accountable Care Organization (ACO) Quality Explorer, a welcome screen displays general information about the tool and its data sources. It also provides a link to the Medicare Shared Savings Program (MSSP), the program from the Centers for Medicare & Medicaid from which the ACO Quality Explorer derives its data. 6 P age
General Features Overall Score Zoom Bar Domains Filter Legend After closing out the Welcome Screen, you will see a map of the continental United States with red, yellow, and green points. Each point represents an accountable care organization that it is taking part in the Medicare Shared Savings Program. On the right-hand side of the screen you will find the ACO Quality Measures by domain, with a large icon next to the Overall Quality Score (ACO Quality Measures) and smaller icons next to each of the domains. Notice that the ACO Quality Measures icon is highlighted in blue, meaning that the red, yellow, and green dots you see on the screen represent the overall score for the five domains. ACOs are displayed as points on the map colored green (4 or more domains with all measures at or above thresholds), yellow (2 or 3 domains with all measures at or above thresholds), or red (less than 2 domains with all measures at or above thresholds). This is also indicated in the legend in the bottom left hand corner. Also note the Change in Costs (from Benchmark) filter below the domains, allowing users to filter by whether ACO has experienced cost increase or decrease from benchmark. Zoom in on the map by doing one of the following: Double-click on the area of interest Hold down the Shift key while you click and drag with your mouse to draw a box on the map Click the (+) on the zoom bar in the upper left-hand corner of the screen Zoom out by clicking the (-) on the zoom bar in the upper left-hand corner of the screen. 7 P age
Flared Rollovers with Indicators by Domain Tool-tip Domains Indicators When you hover over or click on a specific site, flared rollover windows will appear that contain data about the quality measures included in each of the five domains, which will be colored red, yellow, or green based on their value respective to the thresholds. Also note the color for each of the domains: domains are red if at least one of its indicators is red; domains are green if none of its indicators are red. Also notice the tool-tip that appears in the upper left hand corner, which provides general information about the selected accountable care organization. 8 P age
Filter by Domain Selected Domain If you want to focus on one specific domain or indicator, click on the down arrow to the right of the domain name (to see the list of indicators in that domain) and click on the icon to the left of the domain name. Notice that icon next to the selected domain is blue and the colors of the points on the screen changed to reflect the single domain. The fly-out menu now only contains the list of indicators for the selected domain (in this case, Care Coordination/Patient Safety). The color of the domain is reflected by the values of the individual indicators. If an ACO has at least one indicator that is at or below the 30 th percentile threshold, then the domain is colored red. If an ACO does not have any indicators that are at or below the 30 th percentile threshold, then the domain is colored green. 9 P age
Filter by Indicator Selected Indicator If you want to focus on an individual indicator, first select the domain, then click on the icon next to the indicator, then uncheck the remaining indicators in the selected domain. The color of the ACOs are now determined by whether the selected indicator is at or below the 30 th percentile threshold (red), between the 30 th and 90 th percentiles threshold (yellow), or at or greater than the 90 th percentile threshold (green). 10 P age
Filter by Payment Model, Track, or Change in Costs Filters You can filter by Track, by whether an ACO is an Advanced Payment Model Participant, or by whether an ACO has experienced an increase or decrease in costs from a particular benchmark. For example, if you want to filter by Advanced Payment Model Participants, select Yes in the box to see which ACOs are taking part in the program. Now you will only see those ACOs participating in the program on the map. 11 P age
Adjusting Overall Scores/Thresholds Pencil Icon You can adjust the overall scoring by clicking on the pencil icon to the right of ACO Quality Measures. In the pop-up window, drag the slider to adjust to the color of ACOs for the Overall Score. Pencil Icon You can also adjust the thresholds for individual indicators by clicking on the pencil icon next to the indicator. In the pop-up window, drag the slider to select new good (ranges) and bad (red) for the indicator. 12 P age
Data Table Export Data See all of the data for your selected indicator in tabular form by clicking on the Data tab in the upper left-hand corner of the screen. Click on a column header to sort the data by column in ascending or descending order. Download the data table as a.csv file by clicking on the Export button on the upper right-hand side of the screen. 13 P age
Stats Outcome Stats Predictor Community Predictor Continuous/Discrete The Stats function allows you to explore the relationship between ACO quality metrics and population health indicators at the county level. Using the Stats function requires the following: Click on the Stats tab in the upper left hand corner Select an outcome indicator to be your dependent variable (this will select from your ACO dataset) Select a predictor indicator to be your independent variable o You can choose a predictor from your ACO dataset OR o a community predictor (county-level) from HealthLandscape s data library Notice the options in the bottom left hand corner under the Legend heading o Continuous vs Discrete/Ordered Indicators 14 P age
Stats (ACO Predictor) After you ve selected your outcome and predictor indicators from the ACO measures, you will see a scatter plot with line of best fit, showing the correlation between the two indicators. In addition, in the bottom right hand corner you will get some basic statistics, including the Pearsons r (slope), Unstandardized Coefficient, Explained Variance (r-squared), and the Total number of observations. 15 P age
Stats (Community Predictor) If you select a community predictor, you will see the same scatter plot as before with a line of best fit, showing the correlation between the two indicators. However, in this case you are exploring the relationship between the outcome indicator and the community indicator from the county in which the ACO is located. In addition, in the bottom right hand corner you will get some basic statistics, including the Pearsons r (slope), Unstandardized Coefficient, Explained Variance (r-squared), and the Total number of observations. 16 P age
Printing Print Print a map directly from the ACO Quality Explorer by clicking the Print button on the upper righthand side of the screen. In the pop-up window that opens, you can enter a title for your map, and click and drag the map to position it for printing. You also have the option of downloading a data table and/or map as a PDF. Data tables cannot be printed directly from the tool. 17 P age
Reset Button Reset Clear your map and start over by clicking the Reset button on the upper right-hand side of the screen. 18 P age