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The Accountable Care Project: Transforming Systems through Shared Data and Learning

BACKGROUND  

In July 2010, with funding from the Robert Wood Johnson Foundation, the NH Citizen’s Health Initiative (The Initiative), which is staffed through the Institute for Health Policy and Practice (IHPP), launched a value-based health care initiative in the form of a statewide, fiveyear Accountable Care Organization (ACO) pilot project. The Initiative is a multistakeholder collaborative effort working for a health and health care system with better health, better care, and lower costs for all New Hampshire residents.

The ACO pilot project builds on a longterm relationship between The Initiative and several organizations, including provider organizations, commercial payers, population of greater than 400,000 individuals of the total 1.3 million NH citizens, and 700 of the 3,900 practicing clinicians in the state. The systems involved were selected through a competitive application process.

During 2011, the provider, payer and government participants evaluated through research, data analysis and actuarial consultation the feasibility of implementing an ACO financial and reporting framework to be implemented across payers and pilot sites.  The landscape of payment and system reform has evolved significantly since project inception and many of the participants have moved forward with individual payment reform initiatives that no longer made the common New Hampshire ACO framework feasible. 

The Initiative has received strong feedback from participants, however, to continue and expand components of the work established during Year 1 of the project.  Specifically, the next phase of the project focused on the identification of measures, creation of a suite of reports and expansion of the learning community to support NH health systems in their individual transformation and payment reform efforts.

The expanded NH Accountable Care Project (ACP) collaborated to implement a set of cost, utilization and quality reports to support the many system transformation and payment reform initiatives of participating organizations utilizing data available in NH’s All-Payer Claims Data (APCD) system, known as the NH Comprehensive Healthcare Information System (NHCHIS), and through self-reporting of EHR data.

The Accountable Care Project goals include:

To be the trusted source for data & reporting – the reports based NHCHIS is a consistent source, with the same methodology being applied across the partner sites and payers, such that it can be trusted by the various partners (providers, purchasers, payers, etc.)

To provide access to statewide aggregate data and benchmarking information that individual organizations cannot produce from internal data sources

To inform policy making and future system design priorities by strengthening the case that under-served populations realize a disparity in care, using credible data

To assist employers, health plans, and other purchasers in determining how to support changes in care delivery that will improve quality and reduce costs

To collaborate on a common focus to bring down silos in system of care, directing efforts towards education and developing collaborative partnerships; providing a neutral ground for a disparate group to discuss common goals in improving the health care system

THE PATH FORWARD: HEALTHCARE ANALYTICS FOR NEW HAMPSHIRE

The NH Citizens Health Initiative and the Institute for Health Policy and Practice in collaboration with ACP participants have developed and created a set of analytic reports to provide systems undergoing transformation a capacity to compare performance on measures of quality, utilization and cost across systems and regions. The ACP analytic reports include two sets of report types:

Claims-based analytic reports, driven by the NH Comprehensive Health Information System (NHCHIS) data, have both private access for participating organizations and a "public" access for non-participating health care stakeholders. The full report suite includes data for Commercial, Medicaid and Medicare populations.

Electronic Health Record (EHR) quality report, based on self-reported data from participating organizations. The aggregated median rates report provides a benchmark for comparison around key quality measures. The Access to the EHR reporting tool is limited to participating partners.

Project participants have seen great value in the convening of team members for thoughtful discussion around the most relevant analyses to support system transformation in New Hampshire, joint reflection on results and best practices and the ability to compare themselves to the rest of New Hampshire.  The Citizens Health Initiative and the Institute for Health Policy and Practice endeavor to expand the availability of health data, analytics and reporting to support the health of New Hampshire’s population to providers undertaking the significant effort to transform their organizations for the delivery of better health, better healthcare at moderated costs.