Using CMS Data to Set Targets for ACOs

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By David Kelleher | On Fri, 02/08/2013 - 4:45pm

The following is a guest post by David E. Kelleher, President of HealthCare Options, Inc. and Executive Director of the Employers' Forum of Indiana. 

One of the challenges confronting newly formed Accountable Care Organizations (ACOs) is the lack of available information to assist in establishing achievable performance targets. Recently, we happily "discovered" the work of the CMS's Office of Information Products and Data Analytics (OIPDA). The information is available via the Institute of Medicine.  

There is a lot of information here. It is organized by Hospital Referral Region (HRR) for five years, 2007 through 2011 and includes a wealth of information: beneficiary counts, demographics, proportion of patients with different illnesses, total spending, utilization rates and per capita costs in a number of useful breakdowns, hospital compare and PQI information. This could be a somewhat intimidating amount of information.

To show how these data might be used in ACO target setting (or probing for potential areas of improvement) we formatted selected utilization and cost data for the Indianapolis HRR. In the table here, we show 2011 total costs and utilization rates by type of service, incidence (admissions, users) and visit/event utilization rates, cost per admission/user and per event/visit and cost per beneficiary per year (two additional tables are below based off the larger table). For this example, we compared the Indianapolis HRR to the US per capita totals but a state or regional comparison could also be developed from this information set. Similar reports could be developed to compare illness burdens, quality information, demographics etc. 

Since each data line is available for five years, it is possible to trend the information separately for utilization, cost per unit, cost per beneficiary per year, changes in illness burden, and changes in quality indicators. Trending information might foster more finely focused intervention/ improvement strategies. One normal element that appears to be missing is the cost per ER visit (but utilization is reported - see the bottom of the chart). 

This is just one example of what can be done with this data set and I’m sure that many other useful reports could be developed.  To better facilitate the exchange of ideas, it may be worthwhile to convene an ACO-workgroup to share ideas on how to format information so that it can improve the likelihood of success.  For those of you interested in participating, please comment in the space below.

 

Per Capita Costs

Indianapolis

US

2007

$7,695

$8,281

2011

$9,128

$9,539

% Change

18.6%

15.2%

 

Other Information

Indianapolis

US

ER Visits Per Thousand

719

646

Readmission %

18.1%

19.1%

 

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