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Where do I find my ACO content?

Charles Fox
  • Updated

 

Overview

This article summarizes the content on the Analyze page for a selected ACO.

 

TIP-width35.png Click the links below to navigate directly to a section of interest.

  • Insights - The tiles include the most critical metrics to evaluate the selected ACO
  • Destinations - This tab includes four tables that provide summary metrics for organizations participating in the ACO.
    • Hospitals
    • Skilled Nursing Facilities
    • Home Health Agencies
    • Hospices
  • PMPM Details - The "Details" button on the PMPM tile navigates to a sub-page with additional details related to PMPM.

Opening an ACO

You can easily find a specific ACO and navigate to the Analyze page from anywhere in Strategy by using the Global Search at the top of any page.

FindACO.png

1-width22.png Click on the "Search Filters" button to the right of the Global Search field. This will open the selection shown beneath the "Search Filters" button in the image above.

2-width22.png Click on the box to the left of "ACOs - MSSP. This will limit the Global search to ACOs.

3-width22.png Type in as much as you know of the name of the ACO. Notice that typing just "Br" helps us to find the ACOs in the image. If you know the ACO code, you can enter it as well.

When you see the ACO you want to examine, click on the name of the ACO in the list.

 

Page Navigation

The following image highlights the basic navigation tools for the page.

Tabs.png

 

1-width22.png Insights - When you first navigate to the Analyze page for an ACO, the Insights tab is the default.

2-width22.png Metric Definitions - Clicking this link will open a dialog box that contains links to definitions of important terms and concepts.

3-width22.png PMPM Details - Clicking the "Details" button on the PMPM tile opens the "sub-page" of additional content.

4-width22.png Destinations - Clicking on the "Destinations" tab or the "Destinations" button will open the Destinations tab.

 

 

Insights

The following image shows the spread of metrics displayed on and ACO Analyze page. A summary of each tile is included in the table below.

Insights.png

Note-width35.png The metrics displayed on these tiles are calculated for all beneficiaries of the selected ACO.

Metric Tile Details

PMPMTile.png

PMPM/PMPY

  • PMPM represents the Per Member Per Month cost for all MSSP ACO assigned beneficiaries for the selected Date of Service/Calendar Year.
  • Uses beneficiary assignment data in the VRDC.
  • All costs incurred during the selected Date of Service/Calendar Year for these beneficiaries, divided by 12.
  • Use the "Risk Adjusted" toggle to normalize costs for comparison with other ACOs.

Moreinfo-width35.png For more information, see How do we calculate PMPM?

RiskTile.png

Patient Risk Score (HCC)

  • Represents the Hierarchical Condition Category Risk score based on CMS’ methodology for all MSSP ACO assigned beneficiaries.
  • Percentile represents comparison of the MSSP ACO’s HCC to the HCC of all other MSSP ACOs. MSSP ACOs with null or insufficient beneficiaries to calculate HCC are excluded in the comparison.
  • Patient Risk Score Help Article

AllTile.png

All Causes Readmissions

  • Represents MSSP ACO assigned beneficiaries with an Inpatient Admission within 30 days of a Discharge from a previous Inpatient Admission.
  • Readmission could be to the same or different Inpatient facility.
  • Readmissions into Inpatient Rehabilitation Facilities (IRFs) are not included.
  • Planned/elective readmissions are not included.
  • Physicians with <11 beneficiaries are excluded from the denominator.
  • Lookback period is Dec 1st two years ago through Dec 01 one year ago, depending on the time period selected.
  • Percentile represents comparison of the All Causes Readmissions to the All Causes Readmissions of all other MSSP ACOs.
  • MSSP ACOs will null or insufficient beneficiaries to calculate All Causes Readmissions are excluded in the comparison.

PopTile.png

Patient Population Beneficiaries

  • Represents a count of MSSP ACO assigned beneficiaries for the selected Network and Performance Year.

LeakTile.png

Network Leakage

  • Based on MSSP ACO assigned beneficiaries.
  • Leakage represents claims for the selected MSSP ACO;s assigned beneficiaries who were admitted to a SNF, Home Health Agency or Hospital that is not participating in the ACO.
  • Outpatient or Physician Professional claims are not included.
  • Network Leakage calculation identifies the percentage of events occurring at a provider not participating in the MSSP ACO.
  • Percentile represents comparison of the MSSP ACO’s Network Leakage to the Network Leakage of all other MSSP ACOs.
  • MSSP ACOs with null or insufficient beneficiaries to calculate Network Leakage are excluded in the comparison.

Note-width35.png Missing Network Leakage numbers could be due to an MSSP ACO having Physician Groups only (no facilities) or with a facility legal business name that does not match the organization name given in the NPI registry.

SNFTile.png

SNF Admissions

  • Represents MSSP ACO assigned beneficiaries with SNF admissions from any SNF claim with a SNF code.
  • SNF admissions are counted distinctly per beneficiary, i.e. if one person is admitted more than once any time in the Date of Service/Calendar Year, they are only counted as one SNF admission.
  • Admissions into Inpatient Rehabilitation Facilities (IRF) are not included.
  • Percentile represents comparison of the SNF Admissions for the selected ACO to the SNF admissions of all other MSSP ACOs.
  • MSSP ACOs with null or insufficient beneficiaries to calculate SNF admissions are excluded in the comparison.

EDOBSTile.png

ED/OBS Visits

  • Represents MSSP ACO assigned beneficiaries with Outpatient claims with an Emergency Department or Observation code.
  • ED Visits leading to an Inpatient Admission are excluded.
  • ED/OBS visits are counted distinctly per beneficiary, i.e. if one person visits the ED more than once any time in the Date of Service/Calendar Year, they are only counted as one visit.
  • Percentile represents comparison of the ED/OBS visits for the selected ACO to the ED/OBS visits of all other MSSP ACOs.
  • MSSP ACOs will null or insufficient beneficiaries to calculate ED/OBS visits are excluded in the comparison.

INPTile.png

Inpatient Admissions

  • Represents MSSP ACO assigned beneficiaries with inpatient admissions from any inpatient claim with an inpatient code.
  • Inpatient admissions are counted distinctly per beneficiary, i.e. if one person is admitted more than once any time in the Date of Service/Calendar Year, they are only counted as one Inpatient Admission.
  • Inpatient admissions can be at the same or a different inpatient facility.
  • Admissions into Inpatient Rehabilitation Facilities (IRF) are not included.
  • Percentile represents comparison of the inpatient admissions for the selected ACO to the inpatient admissions of all other MSSP ACOs.
  • MSSP ACOs with null or insufficient beneficiaries to calculate inpatient admissions are excluded in the comparison.

HHATile.png

Home Health Admissions

  • Represents MSSP ACO assigned beneficiaries with home health admissions from any home health claim with a home health code.
  • Home health admissions are counted distinctly per beneficiary, i.e. if one person is admitted more than once any time in the Date of Service/Calendar Year, they are only counted as one home health admission.
  • The percentile represents comparison of the home health admissions for the selected ACO to the home health admissions of all other MSSP ACOs.
  • MSSP ACOs with null or insufficient beneficiaries to calculate home health admissions are excluded in the comparison.

HOSTile.png

Hospice Admissions

  • Represents MSSP ACO assigned beneficiaries with hospice admissions from any hospice claim with a hospice code.
  • Hospice admissions are counted distinctly per beneficiary, i.e. if one person is admitted more than once any time in the Date of Service/Calendar Year, they are only counted as one hospice admission.
  • The percentile represents comparison of the hospice admissions for the selected ACO to the hospice admissions of all other MSSP ACOs.
  • MSSP ACOs with null or insufficient beneficiaries to calculate hospice admissions are excluded in the comparison.

 

 

Destinations

When you click on the "Destinations" tab, or on the "Destinations" button on the Patient Population Beneficiaries tile, either route will open the Destinations tab.

There are four tables on the Destinations tab.

TIP-width35.png Click on the name of each table to navigate to the details for the table.

 

 

Hospital Destinations

HospDest.png

 

  Column/Metric Name Description
Provider Identification Name Hospital name where the inpatient/outpatient claim was filed
NPI NPI for listed provider
State State of the hospital where the listed facility claim was filed
County County of the hospital where the listed facility claim was filed
City City of the hospital where the listed facility claim was filed
  Hospital Admit/Visit Count The count of inpatient admissions or outpatient claims for this ACO's assigned lives at the listed facility beginning during the selected time period
  Hospital Beneficiary Count The count of the selected ACO's distinct assigned lives with inpatient admissions or outpatient claims at the listed facility during the selected time period
30-Day All Cause Readmissions Non-Risk Adjusted - This ACO The percentage of the selected ACO's assigned lives who were discharged from the listed facility during the selected time period and readmitted to any hospital within 30 days of discharge
Non-Risk Adjusted - All FFS The percentage of patients who were readmitted to any hospital within 30 days of discharge from the listed facility
Risk Adjusted - This ACO The risk-adjusted percentage of the selected ACO's assigned lives who were discharged from the listed facility during the selected time period and readmitted to any hospital within 30 days of discharge
Risk Adjusted - All FFS The risk-adjusted percentage of patients who were readmitted to any hospital within 30 days of discharge from the listed facility
Average Patient Risk This ACO Average Hierarchical Condition Category (HCC) Patient Risk Score for the selected ACO's assigned lives admitted to the listed facility during the selected time period
All FFS Average Hierarchical Condition Category (HCC) Patient Risk Score for patients admitted to the listed facility during the selected time period
Length of Stay This ACO The average length of inpatient stay (in days) for the selected ACO's assigned lives who were admitted to and discharged from the listed hospital during the selected time period
All FFS The average length of inpatient stay (in days) for all patients admitted to and discharged from the listed hospital during the selected time period
Average Reimbursement Non-Risk Adjusted - This ACO Average Medicare spend per inpatient admission/outpatient claim for the selected ACO's assigned lives with visits or admissions to the listed facility beginning during the selected time period
Non-Risk Adjusted - All FFS Average Medicare spend per inpatient admission/outpatient claim for all patients with visits/admissions to the listed facility beginning during the selected time period
Risk Adjusted - This ACO Average risk-adjusted Medicare spend per inpatient admission/outpatient claim for the selected ACO's assigned lives with visits or admissions to the listed facility beginning during the selected time period
Risk Adjusted - All FFS Average risk-adjusted Medicare spend per inpatient admission/outpatient claim for all patients with visits/admissions to the listed facility beginning during the selected time period

 

 

 

SNF Destinations

 

SNFDest.png

 

  Column/Metric Name Description
Provider Identification Name Organization name where the SNF claim was filed
NPI NPI for listed provider
State State of the SNF where the listed facility claim was filed
County County of the SNF where the listed facility claim was filed
City City of the SNF where the listed facility claim was filed
  SNF Admit Count Count of skilled nursing admissions for this ACO's assigned lives at the listed SNF during the selected time period
  SNF Beneficiary Count Count of this ACO's distinct assigned lives admitted to the listed facility during the selected time period
30-Day All Cause Readmissions Non-Risk Adjusted - This ACO Percentage of the selected ACO's assigned lives who were discharged from an inpatient setting into the listed SNF during the selected time period and readmitted to any inpatient setting within 30 days of the first inpatient discharge
Non-Risk Adjusted - All FFS Percentage of patients who came from an inpatient setting into the listed SNF and were subsequently readmitted to any inpatient setting within 30 days of the first inpatient discharge
Risk Adjusted - This ACO Risk-adjusted percentage of the selected ACO's assigned lives who were discharged from an inpatient setting into the listed SNF during the selected time period and readmitted to any inpatient setting within 30 days of the first inpatient discharge
Risk Adjusted - All FFS Risk-adjusted percentage of patients who came from an inpatient setting into the listed SNF and were subsequently readmitted to any inpatient setting within 30 days of the first inpatient discharge
Average Patient Risk This ACO Average Hierarchical Condition Category (HCC) Patient Risk Score for the selected ACO's assigned lives admitted to the listed SNF during the selected time period
All FFS Average Hierarchical Condition Category (HCC) Patient Risk Score for patients admitted to the listed SNF during the selected time period
Length of Stay This ACO Average length of skilled nursing stay (in days) for the selected ACO's assigned lives who were admitted to and discharged from the listed SNF during the selected time period
All FFS Average length of skilled nursing stay (in days) for all patients admitted to and discharged from the listed SNF during the selected time period
Average Reimbursement Non-Risk Adjusted - This ACO Average Medicare spend per admission for the selected ACO's assigned lives admitted to the listed SNF during the selected time period
Non-Risk Adjusted - All FFS Average Medicare spend per admission for all patients admitted to the listed SNF during the selected time period
Risk Adjusted - This ACO Average risk-adjusted Medicare spend per admission for the selected ACO's assigned lives admitted to the listed SNF during the selected time period
Risk Adjusted - All FFS Average risk-adjusted Medicare spend per admission for all patients admitted to the listed SNF during the selected time period

 

 

 

 

HHA Destinations

 

HHADest.png

 

  Column/Metric Name Description
Provider Identification Name Organization name where the home health claim was filed
NPI NPI for listed provider
State State of the home health agency where the listed facility claim was filed
County County of the home health agency where the listed facility claim was filed
City City of the home health agency where the listed facility claim was filed
  Home health Admit Count Count of home health admissions for the selected ACO's assigned lives to the listed home health agency during the selected time period
  Home health Beneficiary Count Count of the selected ACO's distinct assigned lives admitted to the listed home health agency during the selected time period
30-Day All Cause Readmissions Non-Risk Adjusted - This ACO Percentage of the selected ACO's assigned lives who were discharged from an inpatient setting into the listed home health agency during the selected time period and readmitted to any inpatient setting within 30 days of the first inpatient discharge
Non-Risk Adjusted - All FFS Percentage of patients discharged from any inpatient setting into the listed home health agency and subsequently readmitted to any inpatient setting within 30 days of the first inpatient discharge
Risk Adjusted - This ACO Risk adjusted percentage of the selected ACO's assigned lives who were discharged from an inpatient setting into the listed home health agency during the selected time period and readmitted to any inpatient setting within 30 days of the first inpatient discharge
Risk Adjusted - All FFS Risk adjusted percentage of patients discharged from any inpatient setting into the listed home health agency and subsequently readmitted to any inpatient setting within 30 days of the first inpatient discharge
Average Patient Risk This ACO Average Hierarchical Condition Category (HCC) Patient Risk Score for the selected ACO's assigned lives admitted to the listed home health agency during the selected time period
All FFS Average Hierarchical Condition Category (HCC) Patient Risk Score for patients admitted to the listed home health agency during the selected time period
Length of Stay This ACO Average length of home health stay (in days) for the selected ACO's assigned lives who were admitted to and discharged from the listed home health agency during the selected time period
All FFS Average length of home health stay (in days) for all patients admitted to and discharged from the listed home health agency during the selected time period
Average Reimbursement Non-Risk Adjusted - This ACO Average Medicare spend per admission for the selected ACO's assigned lives admitted to the listed home health agency during the selected time period
Non-Risk Adjusted - All FFS Average Medicare spend per admission for all patients admitted to the listed home health agency during the selected time period
Risk Adjusted - This ACO Average risk-adjusted Medicare spend per admission for the selected ACO's assigned lives admitted to the listed home health agency during the selected time period
Risk Adjusted - All FFS Average risk-adjusted Medicare spend per admission for all patients admitted to the listed home health agency during the selected time period

 

 

 

 

Hospice Destinations

 

HOSDest.png

 

 

  Column/Metric Name Description
Provider Identification Name Organization name where the hospice claim was filed
NPI NPI for listed provider
State State of the hospice where the listed facility claim was filed
County County of the hospice where the listed facility claim was filed
City City of the hospice where the listed facility claim was filed
  Hospice Admit Count Count of hospice admissions for the selected ACO's assigned lives at the listed hospice during the selected time period
  Hospice Beneficiary Count Count of this ACO's distinct assigned lives admitted to the listed hospice during the selected time period
30-Day All Cause Readmissions Non-Risk Adjusted - This ACO Percentage of the selected ACO's assigned lives who were discharged from an inpatient setting into the listed hospice during the selected time period and readmitted to any inpatient setting within 30 days of the first inpatient discharge
Non-Risk Adjusted - All FFS Percentage of patients discharged from any inpatient setting into the listed hospice and subsequently readmitted to any inpatient setting within 30 days of the first inpatient discharge
Risk Adjusted - This ACO Risk adjusted percentage of the selected ACO's assigned lives who were discharged from an inpatient setting into the listed hospice during the selected time period and readmitted to any inpatient setting within 30 days of the first inpatient discharge
Risk Adjusted - All FFS Risk adjusted percentage of patients discharged from any inpatient setting into the listed hospice and subsequently readmitted to any inpatient setting within 30 days of the first inpatient discharge
Average Patient Risk This ACO Average Hierarchical Condition Category (HCC) Patient Risk Score for the selected ACO's assigned lives admitted to the listed hospice during the selected time period
All FFS Average Hierarchical Condition Category (HCC) Patient Risk Score for patients admitted to the listed hospice during the selected time period
Length of Stay This ACO Average length of home health stay (in days) for the selected ACO's assigned lives who were admitted to and discharged from the listed hospice during the selected time period
All FFS Average length of home health stay (in days) for all patients admitted to and discharged from the listed hospice during the selected time period
Average Reimbursement Non-Risk Adjusted - This ACO Average Medicare spend per admission for the selected ACO's assigned lives admitted to the listed hospice during the selected time period
Non-Risk Adjusted - All FFS Average Medicare spend per admission for all patients admitted to the listed hospice during the selected time period
Risk Adjusted - This ACO Average risk-adjusted Medicare spend per admission for the selected ACO's assigned lives admitted to the listed hospice during the selected time period
Risk Adjusted - All FFS Average risk-adjusted Medicare spend per admission for all patients admitted to the listed hospice during the selected time period

 

 

 

 

 

 

PMPM Details

When you click on the PMPM "Details" button, a sub page appears:

PMPMTile2.png

 

This subpage has two sections. The top section pertains to the ACOs PMPM spend. The lower section is a table of all ACO physicians.

 

ACO Spend

PMPMChart2.png

1-width22.png The Calendar Year dropdown will allow you to choose which calendar year is displayed on the page. This will allow you to make more far reaching historical analysis of the selected ACO.

mceclip0.png

 

2-width22.png The PMPM Tile is the same as what was displayed under the insights tab.

3-width22.png The chart shows the trend of monthly PMPM spend for the selected calendar year and the previous year.

If you hover over one of the circles in the chart, a pop-up will show the actual numbers for the selected month.

mceclip1.png

Note-width35.png Since the chart shows the calendar year rather than a rolling four quarters, any unreported quarters will be shown as zeros in the chart. (see image above.)

4-width22.png To the right of the chart you will find the ACOs total patient spend for each year shown in the chart.

 

 

ACO Physicians

This table includes summary metrics for all Physicians in the ACO.

NoNameTable.png

 

Metric name Description

Name

The physician's name
NPI The physician's NPI
State The state listed in the physician's primary practice address from the NPI registry
City The City listed in the physician's primary practice address from the NPI registry
County/ZIP The county/ZIP code listed in the physician's primary practice address from the NPI registry
Specialty The physician's self-reported primary specialty from the NPI Registry
PMPM-All This column contains the total per member, per month spend for all patients for whom the physician is listed as the attending or performing physician on a FFS claim during the performance year (PMPM)
Beneficiary Patient Count - All This metric is the count of patients for whom the physician is listed as the attending or performing physician on a FFS claim in the performance year
Risk Score - All The average HCC Risk Score of patients for whom the physician is listed as the attending or performing physician on a FFS claim in the performance year

 

 

 

ACOs on the Explore page

The Analyze page provides a basic view of metrics for a selected ACO. This is a good place to start your evaluation. If you want to look at the same lists of providers as the tables above but with more and different metrics, Do the following:

  1. Navigate to the Explore page
  2. Click on the provider type of interest among the top tabs.
  3. Click on the filter "MSSP ACO"
  4. Search for your desired ACO. Do NOT click the year - that will select all ACOs available for the selected year.
  5. Select the ACO
  6. Click on the filter button again.

At this point you can click on "Add Metrics" to add any additional metrics of interest.

 

EXPACOPhys.png

 

 

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