The following 31 quality measures are tracked by Medicare Accountable Care Organizations, many of which are Advanced Alternative Payment Models. Emphasis is placed on care coordination across sites, safety, patient experience, and preventive and chronic care management.
Not all Advanced APMs track these 31 measures. The specific quality metrics used in Advanced APMs vary depending on the APM. For instance, the Oncology Care Model naturally focuses on oncology-specific metrics.
Medicare ACO quality metrics
Patient and caregiver experience
These metrics are scored via the Consumer Assessment of Healthcare Providers and Systems survey:
- Getting timely care, appointments and information.
- How well providers communicate.
- Patient rating of provider.
- Access to specialists.
- Health promotion and education.
- Shared decision-making.
- Health status and functional status.
- Stewardship of patient resources.
Care coordination and patient safety
- Readmission metrics:
- 30-day readmission rate for all conditions.
- 30-day all-cause readmission rate from skilled nursing facilities.
- All-cause, unplanned readmission rate for older patients with diabetes.
- All-cause, unplanned readmission rate for older patients with heart failure.
- All-cause, unplanned readmission rate for older patients with multiple chronic conditions.
- Admission rates for three ambulatory sensitive conditions: dehydration, bacterial pneumonia and urinary tract infection.
- Use of certified electronic health record technology.
- Medication reconciliation post-discharge.
- Falls: screening for future fall risk.
- Use of imaging studies for low-back pain.
- Influenza immunization.
- Pneumonia vaccine for older adults.
- Body mass index screening and follow-up.
- Tobacco-use screening and cessation intervention.
- Screening for clinical depression and follow-up plan.
- Colorectal cancer screening.
- Breast cancer screening.
- Statin therapy for prevention and treatment of cardiovascular disease.
- Depression remission at 12 months.
- Diabetes: hemoglobin A1c poor control.
- Diabetes: eye exam.
- Hypertension: controlling high blood pressure.
- Ischemic vascular disease: use of aspirin or another antithrombotic.
Source: Centers for Medicare & Medicaid Services, Accountable Care Organization 2017 Quality Measure Narrative Specifications