Review of Medicare, Medicaid, and commercial quality of care measures: Considerations for assessing accountable care organizations

Journal of Health Politics, Policy and Law

Volumn 40, Issue 4, 2015, Pages 761-796

  Kessell, Eric ^a   Pegany, Vishaal ^b   Keolanui, Beth ^a   Fulton, Brent D ^a   Scheffler, Richard M ^a   Shortell, Stephen M ^c  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Medicaid; Medicare; Private sector; Public sector; Quality of care measures

Indexed keywords

ACCOUNTABLE CARE ORGANIZATION; HEALTH CARE QUALITY; HUMAN; INFORMATION SYSTEM; MEDICAID; MEDICARE; NONBIOLOGICAL MODEL; ORGANIZATION AND MANAGEMENT; PATIENT SATISFACTION; PROCEDURES; STANDARDS; TOTAL QUALITY MANAGEMENT; TREATMENT OUTCOME; UNITED STATES;

ACCOUNTABLE CARE ORGANIZATIONS; HUMANS; INFORMATION SYSTEMS; MEDICAID; MEDICARE; MODELS, ORGANIZATIONAL; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); PATIENT SATISFACTION; PRIVATE SECTOR; PUBLIC SECTOR; QUALITY IMPROVEMENT; QUALITY INDICATORS, HEALTH CARE; QUALITY OF HEALTH CARE; UNITED STATES;

EID: 84950135493     PISSN: 03616878     EISSN: 15271927     Source Type: Journal    
DOI: 10.1215/03616878-3150050     Document Type: Article

References (29)

1. AHRQ(Agency for Healthcare Research andQuality). 2014a. "Principles for the National Quality Strategy (NQS)." www.ahrq.gov/workingforquality/nqs/principles.htm.
2. AHRQ (Agency for Healthcare Research and Quality). 2014b. "Selecting Quality Measures." www.qualitymeasures.ahrq.gov/tutorial/selecting.aspx.
3. BCBSMA (Blue Cross Blue Shield of Massachusetts). 2012. "Massachusetts Payment Reform Model: Results and Lessons." Boston: BCBSMA. www.bluecrossma.com /visitor/pdf/aqc-results-white-paper.pdf.
4. Bellin-ThedaCare. 2014. "Bellin-ThedaCare Health Partners Are #1 in Improving Quality and Costs of Care in CMS Pilot Program." www.thedacare.org/News-and -Events/Company-News/Bellin-ThedaCare-Health-Partners-are-1-in-Improving -Quality-of-Care.aspx.
5. Broderick, Joan E., Stefan Schneider, Doerte U. Junghaenel, Joseph E. Schwartz, and Arthur A. Stone. 2013. "Validity and Reliability of Patient-Reported Outcomes Measurement Information System Instruments in Osteoarthritis." Arthritis Care and Research 65, no. 10: 1625-33.
6. CMS (Centers for Medicare and Medicaid Services). 2012. "Accountable Care Organization 2013 Program Analysis-Quality Performance Standards Narrative Measure Specifications." Baltimore: CMS. www.cms.gov/Medicare/Medicare -Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards .html (see "2013 ACO Quality Reporting Documentation" link).
7. CMS (Centers for Medicare and Medicaid Services). 2013. "Quality Measures." www .cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Quality Measures/index.html?redirect=/qualitymeasures.
8. CMS (Centers for Medicare and Medicaid Services). 2014. "Fact Sheets: Medicare ACOs Continue to Succeed in Improving Care, Lowering Cost Growth." Baltimore: CMS. www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-09-16.html.
9. Colla, Carrie H., Valerie A. Lewis, Stephen M. Shortell, and Elliott Fisher. 2014. "First National Survey of ACOs Finds That Physicians Are Playing Strong Leadership and Ownership Roles." Health Affairs 33, no. 6: 964-71.
10. Colla, Carrie H., David E. Wennberg, Ellen Meara, Jonathan S. Skinner, Daniel J Gottlieb, Valerie A. Lewis, Christopher M. Snyder, and Elliott Fisher. 2012 "Spending Differences Associated with the Medicare Physician Group Practice Demonstration." JAMA 308, no. 10: 1015-23.
11. Donabedian, Avedis. 1988. "The Quality of Care: How Can It Be Assessed?" JAMA 260, no. 12: 1743-48.
12. Harvard Medical School. 2012. "Global Budget Payment Model Lowers Medical Spending, Improves Quality." Cambridge, MA: Harvard Medical School. www .bluecrossma.com/visitor/pdf/hms-bcbsma-aqc.pdf.
13. HHS (US Department of Health and Human Services). 2013. "2013 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care." Washington, DC: HHS. www.ahrq.gov/workingforquality/nqs/nqs2013annlrpt.htm.
14. IHA (Integrated Healthcare Association). 2015. "Recommended Measure Set for Measurement Year 2015." www.iha.org/pdfs_documents/p4p_california/MY-2015 -Measure-Set-20150127.pdf.
15. Kerwin, George. 2012. "Bellin-ThedaCare Healthcare Partners-a Pioneer Accountable Care Organization." Green Bay, WI: Bellin Health. uwphi.pophealth.wisc .edu/programs/health-policy/ebhpp/events/20120222/kerwin.pdf.
16. Krantz, Mori J., Carrie A. Brown, and Philip S. Mehler. 2013. "The Value of a Safety-Net Hospital Case Example: Denver Health." Journal of Ambulatory Care Management 36, no. 3: 178-86.
17. Markovich, Paul. 2012. "A Global Budget Pilot Project among Provider Partners and Blue Shield of California Led to Savings in First TwoYears." Health Affairs 31, no. 9: 1969-76.
18. Miranda, Kristen. 2013. "California Case Study: A Model for Accountable Care." San Francisco: Blue Shield of California. www.iom.edu/*/media/Files/Activity%20Files/Quality/VSRT/Roundtable%20Meetings/March-20-2013/Miranda.pdf.
19. Muhlestein, David, Paul Gardner, Thomas Merrill, Matthew Petersen, and Tianna Tu 2014. "A Taxonomy of Accountable Care Organizations: Different Approaches to Achieve the Triple Aim." Salt Lake City, UT: Leavitt Partners. leavittpartners.com /wp-content/uploads/2014/06/A-Taxonomy-of-Accountable-Care-Organizations.pdf.
20. NCQA (National Committee for Quality Assurance). 2014. "NCQA HEDIS Measures: Summary Table of Measures, Product Lines and Changes." www.ncqa.org /Portals/0/HEDISQM/HEDIS2014/List_of_HEDIS_2014_Measures.pdf. Washington, DC: NCQA.
21. NCQA (National Committee for Quality Assurance). n.d. "Top 20 Private Health Insurance Plan Rankings 2013-14." www.ncqa.org/ReportCards/HealthPlans /HealthInsurancePlanRankings/PrivateHealthPlanRankings20132014.aspx (accessed May 6, 2015).
22. NQF (National Quality Forum). 2014. "What We Do." 2014. www.qualityforum.org /what_we_do.aspx.
23. Ryan, Andrew M., and Jan Blustein. 2011. "The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality." Health Services Research 46, no. 3: 712-28.
24. Shih, Anthony, and Stephen C. Schoenbaum. 2007. "Measuring Hospital Performance: The Importance of Process Measures." New York: Commonwealth Fund www.commonwealthfund.org/publications/data-briefs/2007/jul/measuring-hospital -performance-the-importance-of-process-measures.
25. Song, Zirui, Sherri Rose, Dana Gelb Safran, Bruce E. Landon, Matthew P. Day, and Michael E. Chernew. 2014. "Changes in Health Care Spending and Quality Four Years into Global Payment." New England Journal of Medicine 371, no. 18: 1704-14.
26. Song, Zirui, Dana Gelb Safran, Bruce E. Landon, Mary Beth Landrum, Yulei He, Robert E. Mechanic, Matthew P. Day, and Michael E. Chernew. 2012. "The 'Alternative Quality Contract,' Based on a Global Budget, Lowered Medical Spending and Improved Quality." Health Affairs 31, no. 8: 1885-94.
27. Torchiana, David F., Deborah G. Colton, Sandhya K. Rao, Sarah K. Lenz, Gregg S Meyer, and Timothy G. Ferris. 2013. "Massachusetts General Physicians Organization's Quality Incentive Program Produces Encouraging Results." Health Affairs 32, no. 10: 1748-56.
28. Toussaint, John, Arnold Milstein, and Stephen M. Shortell. 2013. "How the Pioneer ACO Model Needs to Change: Lessons from Its Best-Performing ACO." JAMA 310, no. 13: 1341-42.
29. Yegian, Jill, and Dolores Yanagihara. 2013. "Value Based Pay for Performance in California." Issue Brief No. 8. Oakland, CA: Integrated Health Association. www .iha.org/pdfs_documents/p4p_california/Value-Based-Pay-for-Performance-Issue -Brief-September-2013.pdf.