Population Health Management Flashcards
What is the name of the government agency responsible for Medicare and Medicaid? Abbreviation?
Center for Medicare and Medicaid Services (CMS)
In Aug 2011, CMS announced the results of a study on Accountable Care Organizations.
What was the name of the study?
Physician Group Practice (PGP) Demonstration project
Source: “Lessons from the Physician Group Practice Demonstration — A Sobering Reflection” (New England Journal of Medicine, 11/2011)
In Aug 2011, CMS announced the results of a study on Accountable Care Organizations.
How did the study come about? What years did it run?
The demo resulted from a directive by Congress in 2000 to test ways to encourage physicians who were part of traditional (fee-for-service) Medicare to provide higher-quality care at lower cost and to be rewarded for doing so with a share of the savings they produced. 2005-2010. There was a follow-on study that all 10 PGPs participated in (Jan 2011 - Jan 2013)
Source: “Lessons from the Physician Group Practice Demonstration — A Sobering Reflection” (New England Journal of Medicine, 11/2011)
In Aug 2011, CMS announced the results of a study on Accountable Care Organizations.
Who were the participants?
10 large Physician Group Practices (PGPs). All were multispecialty groups, many with well-known names:
- Marshfield Clinic
- Geisinger
- Park Nicollet
- Billings
- 2 associated with academic medical centers: University of Michigan and Dartmouth
Source: “Lessons from the Physician Group Practice Demonstration — A Sobering Reflection” (New England Journal of Medicine, 11/2011)
In Aug 2011, CMS announced the results of a study on Accountable Care Organizations.
How did the study work?
Physician groups in the demo received their regular Medicare payments for services provided to beneficiaries but could also share in the savings generated as long as they:
- Met certain quality metrics
- Exceeded a savings threshold of 2%
Source: “Lessons from the Physician Group Practice Demonstration — A Sobering Reflection” (New England Journal of Medicine, 11/2011)
In Aug 2011, CMS announced the results of a study on Accountable Care Organizations.
What was the good news?
The PGPs did very well on the quality metrics during all 5 years of the demo.
In the fourth year, all 10 groups met at least 29 of the 32 quality goals.
By the fifth year, seven groups achieved benchmark-level performance on all 32 measures, and the remaining groups did so on at least 30 measures.
In addition, the PGPs increased their quality scores on diabetes, heart-failure, and cancer-screening measures by at least 9 percentage points over the 5 years
Source: “Lessons from the Physician Group Practice Demonstration — A Sobering Reflection” (New England Journal of Medicine, 11/2011)
In Aug 2011, CMS announced the results of a study on Accountable Care Organizations.
What was the bad news?
It’s the financial results reported by CMS that make the PGP news sobering — especially given the length of time most of these physician groups have been operating and the high regard in which they’re held.
- Even with all their experience, only two of the PGP participants were able to exceed a 2% savings threshold the first year of the demo, and only half managed to surpass that threshold after 3 years.
- Even within this group, the shared savings varied widely among the PGPs:
- Marshfield Clinic earned about half of the total savings
- Michigan, Dartmouth, and St. John’s each earned about 15%
- Geisinger earned about 5%
It’s important to understand why only half of these 10 experienced PGPs were able to achieve the 2% savings threshold — partly because the results are unexpected and, more important, because of what they suggest about the likelihood of success for ACOs. The minimum savings threshold that CMS has proposed for ACOs is also 2% (or 3.9% for plans with fewer patients), but plans will have to share losses as well as gains by year 3.
Source: “Lessons from the Physician Group Practice Demonstration — A Sobering Reflection” (New England Journal of Medicine, 11/2011)
