Challenge:

Accountable Care Organizations can report on thirty-one specified quality measures to calculate and assess their quality performance resulting in shared savings. Qualidigm while abstracting this data is able to analyze and create a work flow for improved quality performance, resulting in a higher shared savings for the ACO. The ACO quality performance can improve greatly when gaps in care are closed attaining patient compliance and improved patient health.

Solution:

Qualidigm communicates to Provider offices to schedule vpn remote access to their EMR and or onsite appointments to abstract the Quality Measure specifications. Qualidigm enters all data into the CMS Portal for the ACO and reports weekly to the them the current performance. Qualidigm performs quarterly monitoring of selected quality measure specifications to identify gaps in care to report to client as a proactive approach to meeting requirements for shared savings. The unique approach is the proactive quarterly monitoring of each office delegated to Qualidigm per the ACO in order to align all offices to operate on the same level to ensure success.

Benefit:

The ACO’s met their CMS GPRO requirement. Incentives are based on meeting the established quality performance standard corresponding to its performance year. The first year is pay-for-reporting then quality measures are phased in to pay-for-performance and national benchmarks are used to calculate the quality score and final sharing rate.