Case Study: Creating Collaborative and Innovative Learning Systems for Accountable Care Organizations

Leading the Way to a More Effective System

Mathematica and its partners are developing a learning system that is focused on peer-to-peer learning to assist the Medicare ACOs in developing the core competencies of accountable care.

- Cameron Williams and Megan Cox, CMMI
Project Facts

During the early phases of this project, we have developed and delivered the following:

  • 22 webinars across the three models on topics such as coordinating post-acute care, understanding financial and quality data reports, and peer-to-peer learning about how some ACOs achieved shared savings.
  • 18 webinars and conference calls conducted with CMS to discuss relevant programmatic and policy changes.
  • 2 innovation pods--that is, a series of intensive, problem-solving meetings--for the Pioneer ACOs on return on investment and measurement in the post-acute care space.
  • 10 one-on-one meetings with Pioneer ACOs to provide technical assistance on the program’s benchmarking methodologies.
  • In-person learning activities, including an in-person collaborative meeting for ACOs in the Boston area. This approach is being expanded to other communities.
  • A two-day conference for the Pioneer ACOs , with a second conference for all three ACOs models planned.
  • A dashboard to enable individual ACOs to see their performance results and benchmark against their peers. CMS can also use the dashboard to view progress across the program.
The Issue

CMMI has given ACOs several payment model options to transform their operations in order to improve their performance. These options allow the ACOs to choose a program that fits with their organizational structure and tolerance for financial risk. It is highly challenging for clinical organizations to move from fee-for-service to value-based care.  A comprehensive learning system will help ACOs handle these challenges efficiently by helping them clarify goals, engage in systematic testing and learning, connect through peer-to-peer learning, and rapidly adapt and spread changes that will produce measurable outcomes.

The Approach

Mathematica and our partners are working closely to develop a learning system for all three categories of ACOs—Pioneer ACOs, ESCOs, and Shared Saving Program ACOs.

Mathematica has experience designing ACO models, assessing ACO needs under health care reform, providing advice for improving payment systems and policies, constructing curricula and interactive libraries, and offering technical assistance to providers. Together with our partners, we’ve developed a strategic plan for a learning system that can be implemented rapidly, will meet the needs of the various types of ACOs, will be flexible and adaptable in close to real time based on qualitative and quantitative data analysis, will be results-oriented, and will be valuable for the ACOs and CMS. Furthermore, our partner organizations have offices in 10 major metropolitan areas, giving us an extensive physical presence in many communities with concentrations of ACOs.

The Impacts

Helping ACOs succeed is a top priority in the continued efforts to reform our health care system. Our knowledge in developing curriculum and implementing shared learning vehicles has brought a strategic focus to the development of ACO learning systems that can meet the needs of all three types of ACOs.

Each ACO varies greatly in experience, size, level of integration, health information technology and data analytic capabilities, target populations, and geographic service area. To ensure our system is responsive to these heterogeneous needs we are:

  • Incorporating peer-to-peer learning opportunities
  • Delivering high quality, evidence-based training materials
  • Providing a flexible, sophisticated educational system, which ensures that the ACOs will become learning organizations

Mathematica is implementing the learning system with webinars, workgroups known as “innovation pods,” in-person learning collaboratives, and an interactive web-based desktop that hosts the dashboard, provides a library of tools and resources, and offers other functionalities that ACOs find useful. Our model enables continuous quality improvement and near real-time modifications to the learning systems based on data collection and the experience of the project team and the participating ACOs. The success of these learning systems will bolster the success of ACOs, enabling them to create a cost-effective system of coordinated quality health care for their patients.

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About the Project

One of the ways the Affordable Care Act seeks to reduce health care costs is by encouraging the formation of Accountable Care Organizations (ACOs). ACOs are groupings of diverse health care providers—such as a hospital, primary care physicians, and specialists—that care for a group of people, and that receive incentives to deliver higher quality care more efficiently.

ACOs aim to create a cohesive framework, encourage accountability, and create incentives and rewards to providers who focus on the overall scope of patient care. By coordinating and integrating care, ACOs can simplify the process for patients, enhance quality and efficiency, and cut costs.

To help ACOs navigate the challenges of achieving accountable care, including service delivery changes and necessary infrastructure changes, the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation (CMS CMMI) selected Mathematica to create and implement comprehensive learning systems for three types of ACOs: Pioneer, End-Stage Renal Disease Seamless Care Organizations (ESCOs), and Shared Savings Program (which includes Advance Payment ACOs).