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The American Journal of Accountable Care March 2019
Safety Net Representation in Federal Payment and Care Delivery Reform Initiatives
J. Mac McCullough, PhD, MPH; Natasha Coult, MS; Michael Genau, MS; Ajay Raikhelkar, MS; Kailey Love, MBA, MS; and William Riley, PhD
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ACO Use of Case Mix Index to Comprehensively Evaluate Postacute Care Partners
Mark E. Lewis, MPH; and Avery M. Day, MPH
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James Howard, MD; Tyler Kent, BS; Amy R. Stuck, PhD, RN; Christopher Crowley, PhD; and Feng Zeng, PhD
Effective Population Health Care Delivery Under Medicare’s Merit-based Incentive Payment System: Realigning Accountability With Capability
Adam S. Wilk, PhD; and Sanjula Jain, PhD
Making Sense of Changes in Healthcare: Lessons From the AcademyHealth National Health Policy Conference
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ACO Use of Case Mix Index to Comprehensively Evaluate Postacute Care Partners

Mark E. Lewis, MPH; and Avery M. Day, MPH
This article describes how one accountable care organization (ACO) created a risk-adjusted algorithm to evaluate current and potential candidates for skilled nursing facility partnerships.
ABSTRACT

Accountable care organizations (ACOs) continually strive to achieve the triple aim: an enhanced patient experience and improved population health at a decreased cost. One area of opportunity identified by a Philadelphia-area ACO (PAACO) to achieve this goal was to decrease skilled nursing facility (SNF) utilization and cost. The PAACO’s 2017 attributed population had utilized more than 130 facilities despite a group of preferred SNFs having been previously determined. There is currently no standard risk-adjusted algorithm for rating SNFs. The PAACO thus created a risk-adjusted algorithm that would rank the facilities based on a weighting system of key indicators of quality. Points were awarded or detracted based on expected amount thresholds; the sum of the points was multiplied by the case mix index, which served as a normalizing factor. The results revealed that the group of preferred SNFs was performing worse than all other facilities included in the analysis. Areas for opportunity were identified for the preferred group, and as a true community partner, the PAACO will work with these facilities to improve their ranking. This approach could not only decrease costs for the PAACO, but also increase the CMS star rating for these facilities.

The American Journal of Accountable Care. 2019;7(1):24-27

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