ACO 101: Overview of Dartmouth-Hitchcock
Health Pioneer ACO Model and OneCare Vermont ACO Models
Lynn Guillette, CPA, MBAMay 3, 2014
2
The U.S. ranks last or next to last in five key areas¹:
Quality
Access
Efficiency
Equity
Healthy Lives
Structural Challenges
Fragmented delivery system with lack of primary care
Lack of evidence based care often drives variation in quality & patient safety
Misalignment of incentives
Transaction-based payment system
Lack of transparency
Limited focus on quality
The Health Care Ecosystem in 2014
¹The Commonwealth Fund – June 2010
3
How Can Dartmouth-Hitchcock Health Address These Challenges?
Change the
Structure
Transform Payment System
from Transaction-
Based to Outcomes-Based
Transform Delivery System
to Patient-Centered Care
System
4
Who is Dartmouth-Hitchcock Health?
Dartmouth-Hitchcock Health
IvyMD
Dartmouth-Hitchcock Clinic
Mary Hitchcock Memorial Hospital
OneCare Vermont ACO,
LLC(50% owner)
New London Health
Association
New England Alliance for
Health
D-H
D-HH’s Work is Focused Into 7 Strategic DomainsUnder 3 Enterprise Core Strategies
Create A Sustainable Health System
Population Health Value-Based Care New Payment Models
Mission, Vision, Values
Improve Quality Outcomes Reduce Cost of Care
Improve Population
HealthInnovation
Leaders in
Value
Integrated Health System
FinanceDistinctive Education & Research
People
The strategic domains provide
additional focus for the D-H enterprise
core strategies
Performance Imperatives >
D-H Enterprise Core Strategies >
5
Creating A Sustainable Health System
VT NH
ME
MA
DHMC
D-H Concord
D-H Manchester
D-H NashuaD-H Keene
D-H Putnam
Population Health
NEAHBoston Children’sSo. NH & Seacoast
Value Based Care
HVHCMayo NNEACCDartmouth CollegeIndustry Partners
New Payment Models
Pioneer•OneCare VT Health Plan Partner
6-Confidential-
•••
• ••
•
Global Capitation
FullyIntegrated
Fee for Service
FragmentedDelivery
Payment Model
Care
Mod
el• Provide care and wellness services to 2+ million people
• Measurably improve population health
• Implement value-based care processes across D-H
• Participate to the fullest extent possible in payment models that recognize the value of care delivered
• Develop an integrated NNE healthcare network
• Refine and expand an integrated NNE support and management services infrastructure
• Enable more care and wellness to be delivered at community level and at home
• Align D-H workforce with enterprise strategies/objectives
• Align research and education to support achievement of a sustainable health system
• Establish innovative partnerships with government and industry that improve care and wellness
• D-H recognized as a national leader in creating value and implementing a sustainable health system
D-H
End-State Goals – Where Are We Heading?The D-H Strategic Operating Plan Matrix helps us to focus on a single year at a time. The 2015 plan will be designed to expand more on our medium to long-term strategic objectives, including:
7
8
To Transform the Payment System, We Need to Learn a New
Language
Accountable Care
Organization
Fee For Service
Pay for Performance
Shared Risk
Global Budget
Payment Model Continuum
Fee-For Service - is a payment model where services are unbundled and paid for separately by service
Pay-For-Performance - introduces quality and efficiency incentives, instead of solely rewarding quantity
Shared Risk - means distributing the cost of health care services across large numbers of participants - including people of various ages and health conditions
Global Budget / Capitation - is a payment arrangement for health care services that pays a physician or group of physicians a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care
Fee-For-Service
Pay-for-Performance
Shared Risk
Global Budget
Capitation
VolumeFocused
ValueFocused
9
Accountable Care Organization (“ACO”) - is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients
10
More about ACOsDocto
rs, Hospitals,
Other Healthcare Providers
Payor(s)
AccountableCare
Organization
(“ACO”)
Providers in an ACO may all belong to the same health system, or may include multiple health systems, independent hospitals, physician groups/practices, and other types of healthcare providers
Providers work together with a payor to provide high quality coordinated care for patients
May include one or more payors
May include any one (or more) of the four payment methodologies outlined on slide 9
Quality performance is measured at the aggregate ACO level
The ACO would be rewarded for providing the ACO’s patients with a positive patient experience, better health outcomes, and reduction in the growth of total cost of care for the ACO patient population
11
What Does D-H’s Payments Models Look Like Today?
12
Dartmouth-Hitchcock Wellness Plus(Administered by Health Plans Inc.)
D-H Employee Health Benefit Plan(s)16,000 lives
Transformation to date at D-H(Directly Managing or Influencing 182,000+ lives)
13
CMS Pioneer ACO Model• CMS Pioneer ACO Model: Medicare shared risk program that
incorporates the ACO concept; ACO has financial risk if actual costs exceed annual cost target but has financial reward opportunity if actual costs are less than annual cost target
• Through competitive application process, D-HH became one of thirty-two Pioneer ACOs in the country
D-HH ACO
Mary Hitchcock Memorial Hospital Dartmouth-Hitchcock Clinic17,536
attributed beneficiaries
Pioneer ACO
15,000 minimum attributed Medicare beneficiaries across entire ACO
Attribution refreshed annually
Two-stage attribution algorithm based on preponderance of qualifying E & M codes provided by primary care and 8 other
specialty types
Primary Care defined as: MDs, DOs, NPs, and PAs practicing in General Practice, Family Practice, Internal Medicine, Geriatric
Medicine
Pioneer ACO Model Attributed Population Requirements
14
Algorithm:Uses a two-stage algorithm for attribution
New providers during performance year:Under Pioneer, the annual TIN/NPI roster may only be revised to reflect providers leaving the ACO during the year. New hires may only be added at time of the annual TIN/NPI roster submission.
8 Specialty Types for 2nd stage of attribution:NephrologyOncologyRheumatologyEndocrinologyPulmonologyNeurologyNeuropsychiatryCardiology
Nurse Practitioners & Physician Assistants: E & M codes billed under the name of a primary care Nurse Practitioner and primary care Physician Assistant “count” for attribution purposes
TIN Commitment:Once the TIN is committed to a Medicare ACO, that TIN is then limited to be a vendor/supplier to other Medicare ACOs.
Better Care for Individuals
Better Health for a
Population
Lower per Capita Costs
The Triple Aim
15
• 7 measures• Possible Points per
Domain = 4• Domain Weight = 25%
• 6 measures• Possible Points per
Domain = 14• Domain Weight = 25%
• 12 measures• Possible Points per
Domain = 14• Domain Weight = 25%
• 8 measures• Possible Points per
Domain = 16• Domain Weight = 25%
Patient/ Caregiver
Experience
Care Coordination/ Patient Safety
At-Risk Population
Health Managemen
t
Preventative Health
Pioneer ACO Model – Quality Comes First in Achieving the Triple Aim4 Domains; 33 Individual Measures; 48 Possible Points in 2013
16
D-HH Pioneer ACO Financial Model – For Illustrative Purposes Only
17
Cost TargetExpected cost per beneficiary per year
times number of attributed beneficiaries$10,000 * 30,000 = $300,000,000
Minimum Savings Rate (MSR) Threshold
Cost Target times 1%$300,000,000 * 1% = $3,000,000
Actual Cost ExpendituresActual cost per beneficiary per year
times number of attributed beneficiaries$9,800 * 30,000 = $294,000,000
Gross SavingsCost Target less Actual Cost Expenditures
$300,000,000 -$294,000,000 = $6,000,000
If Gross Savings Rate > MSR
Gross Savings Rate Gross Savings divided by Cost
Target $6,000,000/$300,000,000 = 2%
ACO Shared SavingsGross Savings times 70%
$6,000,000 * 70%= $4,200,000If Gross Savings or Gross
Loss is 0% to 1%, CMS keeps total savings or
absorbs total loss
Gradient quality scores impact eligible shared savings
Quality Multiplier
Applied (0.00-
100.00)
18
D-HH Pioneer ACO in 2013• For year two, expanded ACO
participation by adding one Critical Access Hospital and its employed physicians
• Criteria for adding NLHA:• D-H & NHLA affiliation discussions
were underway; ACO inclusion would foster continued clinical integration
• NLHA’s Chief Medical Officer was a former D-H physician who had championed accountable care, shared-decision making, evidence-based medicine, and shared the same care coordination philosophy
• NLHA’s patients generally used D-H for specialty care
D-HH ACO
Mary Hitchcock Memorial Hospital
Dartmouth-Hitchcock
Clinic
New London Hospital
Association
25,413 attributed
beneficiaries
19
D-HH Pioneer Expansion in Year 3• D-H determined that it needed to expand Pioneer ACO
participants beyond D-H and NLHA
• Why?• To move closer to achieving our vision of creating a sustainable health
system with the healthiest population possible• To lead the transformation of health care in our region and to set the
standard for the nation
• How?• Create rigor and structure to the expansion identification, selection,
and implementation process• Adequately assess business risk to D-H and its ACO because of
changes in composition of ACO provider participation
20
D-HH Pioneer ACO in 2014D-HH ACO
Mary Hitchcock Memorial Hospital
Dartmouth-
Hitchcock Clinic
New London Hospital
Association
Catholic Medical Center
Exeter Health
Resources/ Core
Physicians
St. Joseph Hospital
46,700 attributed
beneficiaries
Clinical Advisory Council Performance ReportingLeadership Council
21
Medicare Shared Savings Program (“MSSP”) Model
• Medicare Shared Savings Program Model: Medicare shared savings program that incorporates the ACO concept; initial 3-year contract; ACO has no financial risk in any of the first 3 years if actual costs exceed annual cost target but has financial reward opportunity if actual costs are less than annual cost target in any of the first 3 years
• OneCare Vermont ACO, LLC was jointly formed by Fletcher Allen Health Care and Dartmouth-Hitchcock Health in summer of 2012
• Through application process, OneCare Vermont ACO became one of 218 MSSP ACOs in the country (# of ACOs has since grown to 341)
• Others in VT or NH:• Accountable Care Coalition of Green Mountains, LLC (Independent physician practice model in VT)• Community Health Accountable Care, LLC (FQHC-led model in VT and NH)• Concord Elliot ACO, LLC (Hospital system-led model in NH)• North Country ACO (FQHC-led advanced payment model in NH)
Fletcher Allen Health Care Dartmouth-Hitchcock Health
MSSP
5,000 minimum attributed Medicare beneficiaries across entire ACO
Attribution refreshed quarterly
Two-stage attribution algorithm based on preponderance of qualifying E & M codes provided by primary care and all other
specialty types
Primary Care defined as: MDs, and DOs, practicing in General Practice, Family Practice, Internal Medicine, Geriatric Medicine
MSSP Model Attributed Population Requirements
22
Algorithm:Uses a two-stage algorithm for attribution but not the same one used for the Pioneer model
Nurse Practitioners & Physician Assistants: E & M codes billed under the name of a primary care Nurse Practitioner and primary care Physician Assistant DO NOT “count” for attribution purposes
TIN Commitment:Once the TIN is committed to a Medicare ACO, that TIN is then limited to be a vendor/supplier to other Medicare ACOs.
• 7 measures• Possible Points per
Domain = 4• Domain Weight = 25%
• 6 measures• Possible Points per
Domain = 14• Domain Weight = 25%
• 12 measures• Possible Points per
Domain = 14• Domain Weight = 25%
• 8 measures• Possible Points per
Domain = 16• Domain Weight = 25%
Patient/ Caregiver
Experience
Care Coordination/ Patient Safety
At-Risk Population
Health Managemen
t
Preventative Health
MSSP ACO Model – Quality Comes First in Achieving the Triple Aim4 Domains; 33 Individual Measures; 48 Possible Points in 2013
23
24
OneCare Vermont ACO Board of Managers
Chief Executive Officer
Chief Compliance Officer
Chief Operating Officer
Administrative Directors/Staff
Executive Medical Director
Care Management & Quality Directors/Staff
Organizational StructureOCVT Board of Managers Composition (16 seat board): D-HH = 3 seats FAHC = 3 seats Gifford Medical Ctr = 1
seat Private/community
practice physician = 1 seat
Medicare beneficiary = 1 seat
CHS of Lamoille Valley = 1 seat
Southwestern VT Medical Ctr = 1 seat
Primary Care Health Partners = 1 seat
The Howard Center = 1 seat
The Pines at Rutland = 1 seat
Medicaid beneficiary = 1 seat (vacant)
Commercial Exchange consumer = 1 seat (vacant)
OneCare Vermont 2014 MSSP Network
Statewide ACO Provider Network• 2 Academic Medical Centers• 14 Community Hospitals• 1 Behavioral Health/Substance
Abuse Facility• 2 Federally Qualified Health
Centers• 5 Rural Health Clinics• 58 Private Practices
• 280 Primary Care Physicians across Network Participants
• Approximately 42,000 attributed Medicare beneficiaries
Hospitals with Employed Attributing Physicians
Significant Participation from Community Physicians
26
OneCare Vermont ACO MSSP Model
27
• NNEACC: Northern New England Accountable Care Collaborative
• Data Trust owned by Dartmouth College, Dartmouth-Hitchcock, Eastern Maine Health, Fletcher Allen Health Care, and MaineHealth
• Used by both D-HH Pioneer ACO and OneCare Vermont
• Proprietary software tools for:• Care Coordination/Management• Quality Management• Physician/Practice Administrator Management• User Help Desks
NNEACC
Beneficiaries Don’t Join the ACO?
28
Providers and provider organizations join an ACO, not Medicare beneficiaries
Medicare Beneficiaries assigned to a Pioneer ACO or MSSP ACO: Still have traditional FFS Medicare as primary payor Can’t be in a Medicare Advantage Plan Must have Part A and Part B Medicare coverage Can choose any provider or provider organization that accepts
Medicare – are not locked into seeing only ACO participating providers
Medicare beneficiary ID card does not indicate or reference ACO assignment
Do the Beneficiaries Know They’ve Been Assigned to the ACO?
29
Beneficiaries get a one-time notice in the year that they are first assigned to a Pioneer or MSSP ACO
NOTICE TO BENEFICIARIES LETTER: Your Doctor is Participating in an Accountable Care Organization <BENEFICIARY FULL NAME><ADDRESS> <file creation date><CITY STATE ZIP> ACOs: A Way to Better Coordinate Your Health CareYour doctor or primary care provider has chosen to participate in Dartmouth-Hitchcock Health, our Medicare Accountable Care Organization (ACO). An ACO is a group of doctors, hospitals, and health care providers working together with Medicare to give you more coordinated service and care.
We’re Working to Improve Your CareThe goal of an ACO is for your doctors or primary care providers to communicate closely with your other health care providers, so they can deliver high-quality care that meets your individual needs and preferences. ACOs may be rewarded for providing you with high quality, more coordinated care.
Excerpt of
notice
Can the Beneficiaries Opt-Out of ACO Assignment?
30
Beneficiaries cannot opt-out of being assigned to a Pioneer ACO or MSSP ACO, but they can opt-out of allowing CMS to share their personal health information with us
Decline to Consent to Share Information “opt-out” forms mailed out with the Notice to Beneficiaries Letter
If they opt-out, they are still assigned to ACO but ACO will not receive any claims or clinical data from CMS for services provided to these beneficiaries
All Medicare Beneficiaries are automatically opted-out of sharing alcohol & substance abuse dataDate: January 28, 2013
Declining to Share Personal Health Information
Please sign this form if you do NOT want Medicare to share information about care you have received from other healthcare providers with the Dartmouth-Hitchcock Health ACO for use in coordinating your care. You can also call 1-800 MEDICARE (1-800-633-4227) instead of completing this form. TTY users should call 1-877-486-2048. Your decision not to share this personal health information with the Dartmouth-Hitchcock Health ACO will remain in effect until you tell us that you have changed your preference. You may change your decision not to share your personal information at any time. Your request will take effect in approximately 60 business days. Note: Even if you don’t want to share your personal information with the Dartmouth-Hitchcock Health ACO for use in coordinating your care, Medicare will still need to use your information for some purposes, including certain financial calculations and determining the quality of care provided by the Dartmouth-Hitchcock Health ACO. Also, Medicare may share some of your personal health information with the Dartmouth-Hitchcock Health ACO as part of assessing the quality of care your healthcare providers at the Dartmouth-Hitchcock ACO are providing.
Excerpt of form
31
• Development of “Anchor Specialists” and “Medical Neighbors”• Special expertise/focus to support PCP ‘s management of chronic care conditions (e.g. heart failure “expert” within cardiology;
Vascular support from Surgery)
• Need for rapid consult access• Special clinics for commonly encountered problems• Special focus on fragile patients at risk for hospital care• Are bookable office hours per week available to meet this demand?
• Assess OR Efficiency in order to support ACO Hospital• Are case start times inconsistent?• Are block times altered for low volume days?• Are surgeons returning to office on low case OR days?• Are supplies and high-cost implants standardized?
• Do current clinical “standard protocols” need to be revised to be more attractive in ACO environment?• Diagnostic work-ups• Use of shared-decision making• Location of surgery (inpatient, hospital outpatient, ASC, other?)
• Greater emphasis/involvement in post-acute care planning• Use of SNFs/rehab facilities vs. home health services• Encouraging “pre-hab” prior to surgery to potentially reduce post-acute care recovery times and increase patient functional
restoration
What can Specialists do to impact ACO models?
32
• Coordinate care with primary care providers• Encourage beneficiaries to see their primary care provider for annual Medicare Wellness
preventative care visit
• Collaboration between primary care coordinators and specialty care staff/nurses/care coordinators for complex patients (e.g. chronic kidney disease, oncology) and those with rare diseases (e.g. hemophilia)
• Enhance patient satisfaction; what patients think about their specialty care visits matter
• Assist in closing gaps in care
• Emphasis on more precise coding and medical record documentation
• Focus on quality performance measures that could be applicable to specialists
What can Specialists do to impact ACO models?
33
APPENDIX – Pioneer ACO’s 33 Quality
Measures
ACO #
Domain Measure Title NQF Measure#/Measure Steward
Method of Data Submission
P4P Phase-In PY1
P4P Phase-In PY2
P4PPhase-In PY3
1. Patient/Caregiver Experience
CAHPS: Getting Timely Care, Appointments and Information
NQF #5, AHRQ
Survey R P P
2. Patient/Caregiver Experience
CAHPS: How Well Your Doctors Communicate NQF #5, AHRQ
Survey R P P
3. Patient/Caregiver Experience
CAHPS: Patients’ Rating of Doctor NQF #5, AHRQ
Survey R P P
4. Patient/Caregiver Experience
CAHPS: Access to Specialists NQF #5, AHRQ
Survey R P P
5. Patient/Caregiver Experience
CAHPS: Health Promotion and Education NQF #5, AHRQ
Survey R P P
6. Patient/Caregiver Experience
CAHPS: Shared Decision Making NQF #5, AHRQ
Survey R P P
7. Patient/Caregiver Experience
CAHPS: Getting Timely Care, Appointments and Information
NQF #6, AHRQ
Survey R R R
8. Care Coordination/ Patient Safety
Risk-Standardized, All Condition Readmission CMS Claims R R P
9. Care Coordination/ Patient Safety
Ambulatory Sensitive Conditions Admissions: COPD or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)
NQF #275, AHRQ
Claims R P P
10. Care Coordination/ Patient Safety
Ambulatory Sensitive Conditions Admissions: CHF (AHRQ Prevention Quality Indicator (PQI) #8)
NQF #277, AHRQ
Claims R P P
11. Care Coordination/ Patient Safety
Percent of Primary Care Physicians who Successfully Qualify for an EHR Program Incentive Payment
CMS EHR Incentive Program Reporting
R P P
Pioneer ACO Quality Performance Standards MeasuresAIM: Better Care for Individuals
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting
ACO #
Domain Measure Title NQF Measure#/Measure Steward
Method of Data Submission
P4P Phase-In PY1
P4P Phase-In PY2
P4PPhase-In PY3
12. Care Coordination/ Patient Safety
Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility
NQF #97, AMA-PCPI/NCQA
GPRO Web Interface
R P P
13. Care Coordination/ Patient Safety
Falls: Screening for Fall Risk NCQA #101, NCQA
GPRO Web Interface
R P P
Pioneer ACO Quality Performance Standards MeasuresAIM: Better Care for Individuals
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting
AIM: Better Health for PopulationsACO #
Domain Measure Title NQF Measure#/Measure Steward
Method of Data Submission
P4P Phase-In PY1
P4P Phase-In PY2
P4PPhase-In PY3
14. Preventative Health
Influenza Immunization NQF #41, AMA-PCPI
GPRO Web Interface
R P P
15. Preventative Health
Pneumococcal Vaccination NQF #43, NCQA
GPRO Web Interface
R P P
16. Preventative Health
Adult Weight Screening and Follow-up NQF #421, CMS
GPRO Web Interface
R P P
17. Preventative Health
Tobacco Use Assessment and Tobacco Cessation Intervention
NQF #28, AMA-PCPI
GPRO Web Interface
R P P
18. Preventative Health
Depression Screening NQF #418, CMS
GPRO Web Interface
R P P
19. Preventative Health
Colorectal Cancer Screening NQF #34, NCQA
GPRO Web Interface
R R P
20. Preventative Health
Mammography Screening NQF #31, NCQA
GPRO Web Interface
R R P
ACO #
Domain Measure Title NQF Measure#/Measure Steward
Method of Data Submission
P4P Phase-In PY1
P4P Phase-In PY2
P4PPhase-In PY3
21. Preventative Health
Screening for High Blood Pressure CMS GPRO Web Interface
R R P
22. At Risk Population - Diabetes
Diabetes Composite (All or Nothing scoring): Hemoglobin A1C Control (<8 percent)
NQF #729, MN Community Measurement
GPRO Web Interface
R P P
23. At Risk Population - Diabetes
Diabetes Composite (All or Nothing scoring): Low Density Lipoprotein (< 100)
NQF #729, MN Community Measurement
GPRO Web Interface
R P P
24. At Risk Population - Diabetes
Diabetes Composite (All or Nothing scoring): Blood Pressure (< 140/90)
NQF #729, MN Community Measurement
GPRO Web Interface
R P P
25. At Risk Population - Diabetes
Diabetes Composite (All or Nothing scoring): Tobacco Non-Use
NQF #729, MN Community Measurement
GPRO Web Interface
R P P
26. At Risk Population - Diabetes
Diabetes Composite (All or Nothing scoring): Aspirin Use
NQF #729, MN Community Measurement
GPRO Web Interface
R P P
27. At Risk Population - Diabetes
Diabetes Mellitus: Hemoglobin A1C Poor Control (>9 percent)
NQF #59, NCQA
GPRO Web Interface
R P P
28. At Risk Population - Hypertension
Hypertension (HTN): Controlling High Blood Pressure
NQF #18, NCQA
GPRO Web Interface
R P P
29. At Risk Population – Ischemic Vascular Disease
Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (<100 mg/dL)
NQF #75, NCQA
GPRO Web Interface
R P P
10. Care Coordination/ Patient Safety
Ambulatory Sensitive Conditions Admissions: CHF (AHRQ Prevention Quality Indicator (PQI) #8)
NQF #277, AHRQ
GPRO Web Interface
R P P
Pioneer ACO Quality Performance Standards MeasuresAIM: Better Health for Populations
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting
ACO #
Domain Measure Title NQF Measure#/Measure Steward
Method of Data Submission
P4P Phase-In PY1
P4P Phase-In PY2
P4PPhase-In PY3
30. At Risk Population – Ischemic Vascular Disease
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
NQF #68, NCQA
GPRO Web Interface
R P P
31. At Risk Population – Heart Failure
Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
NQF #83, AMI-PCPI
GPRO Web Interface
R R P
32. At Risk Population – Coronary Artery Disease
Coronary Artery Disease (CAD) Composite: All or Nothing Scoring: Drug Therapy for Lowering LDL-Cholesterol
NQF #74, CMS (Composite) /AMA-PCPI (individual component)
GPRO Web Interface
R R P
33. At Risk Population – Coronary Artery Disease
Coronary Artery Disease (CAD) Composite: All or Nothing Scoring: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD)
NQF #66, CMS (Composite) /AMA-PCPI (individual component)
GPRO Web Interface
R R P
Pioneer ACO Quality Performance Standards MeasuresAIM: Better Health for Populations
Note: NQF = National Quality Forum; P4P = pay for performance; P = performance; R = reporting
Top Related