ACO Improvement Sample Clauses
The "ACO Improvement" clause establishes requirements or incentives for an Accountable Care Organization (ACO) to enhance its performance or quality of care over time. Typically, this clause outlines specific benchmarks, metrics, or improvement targets that the ACO must meet, such as reducing hospital readmissions or improving patient satisfaction scores. By setting clear expectations for ongoing progress, the clause encourages continuous improvement and helps ensure that the ACO remains focused on delivering better health outcomes and cost efficiencies.
ACO Improvement a. For each applicable measure, ACO BP2 actual rates are compared to ACO BP1 actual rates
i. For measures where an ACO demonstrates improvement (i.e., reaches the predetermined improvement targets), the ACO earns improvement points
ii. For measures where an ACO fails to demonstrate improvement, then Step 2 is implemented
ACO Improvement. For each composite within a domain, compare ACO BP1 actual rates to BP2 performance rates
ACO Improvement a. For each composite within a domain, compare ACO BP1 actual rates to BP2 performance rates
i. For composites where an ACO demonstrates improvement (i.e., reaches the improvement target), the ACO earns improvement points
ii. For composites where an ACO fails to demonstrate improvement, then Step 2 is implemented
a. If the State sets individual ACOs’ BP2 and BP3 performance rates to be the higher of their actual BP1 or BP2 rates, then for each composite within a domain, compare BP1 statewide median rates to BP2 statewide median rates. If the State sets ACOs’ BP2 and BP3 performance rates to be the higher of their BP2 or BP3 actual rates, then for each composite within a domain, compare BP1 statewide median rates to the higher of BP2 statewide median rates or BP3 statewide median rates.
i. For composites where the State demonstrates improvement (i.e., reaches the improvement target), the ACO earns improvement points
ii. For composites where the State fails to demonstrate targeted improvement, the ACO does not earn improvement points Note: In order to prevent such cases where an ACO’s performance would improve excessively through the use of the statewide median, the number of composites by which an ACO may use Step 2.a.i to earn improvement points is capped at one Note: This example assumes each composite has the same Improvement Target across composites A- D, and that the State is comparing BP1 rates to BP2 rates. Measure Improvement Target = 1.0 State Improvement Median = 1.0 A – Willingness to Recommend (Adult Survey) 75.1% 75.9% 0.8 (target not met by ACO) State Med = 1.0 YES (Step 2 applied) B - Willingness to Recommend (Child Survey) 85.1% 87.0% 1.9 (target met by ACO) ACO = 1.9 YES (Step 2 not needed) C - Communications (Adult Survey) 89.5 88.7% -0.8 (target not met by ACO) State Med = 1.0 NO (Capped at 1: Composite A already received points) D - Communications (Child Survey) 78.1% 78.5% 0.4 (target not met by ACO) State Med = 0.8 (target not met by State) NO EOHHS will establish the attainment threshold and goal benchmark for each Quality Measure. EOHHS anticipates establishing these performance benchmarks as follows: • For Quality Measures based on NCQA HEDIS measures, EOHHS anticipates using NCQA Quality Compass percentile benchmarks where possible • For non-HEDIS claims-based Quality Measures, EOHHS anticipates using existing MassHealth data sources such as MassHealth historical claims or encounter data • For non-HEDIS Clinical Quality Measures, o...