Appendix D ACO Initiatives to Address ACO Model Quality Measures – Measure Current ACO Activities Underway Planned ACO Activities Underway Goal #1: Increase Access to Primary Care Percentage of adults with All of CHAC's FQHC participants are NQCA Plan outreach activities to connect with usual primary care provider PCMH recognized. NCQA's PCMH 2014 "attributed but not seen" patients. FQHCs will standards require FQHCs to have practices in continue with activities that fulfill PCMH place to ensure that patients are assigned a PCP requirements related to PCP assignment. Promote (see Standard 2A: The practice provides best practices of VNAs, CMHCs, and Designated continuity of care for patients/families by: Agencies to ensure patients are properly assigned. Assisting patients/families to select a personal clinician and documenting the selection in practice records; and monitoring the percentage of patient visits with selected clinician or team.) CHAC has also required that other participants (VNAs, and CMHCs) should have practices in places to ensure patients are assigned a PCP. Medicare ACO composite of Annually, CHAC completes the CAHPS survey Same activities planned for next year 5 questions on Getting as a condition of its contract with Medicare. The Timely Care, Appointments data from the survey are reviewed across the and Information CHAC governance entities (Clinical Committee, Board, and the Consumer Advisory Panel) to identify set ACO-level goals and best practices. Percentage of Medicaid Not applicable. Not applicable. adolescents with well-care visits Percentage of Medicaid Not applicable. Not applicable. enrollees aligned with ACO Goal #2: Reduce Deaths Related to Suicide and Drug Overdose Deaths related to suicide CHAC has implemented ACO-wide efforts that Same activities planned for next year focus on depression screening that include questions related to suicide risk. Many of the CHAC participants are engaged in regional/local efforts as well including expanded use of the PHQ2/PHQ9 screenings. At least one CHAC participant is engaged in a Zero Suicide pilot. CHAC monitors these
Appendix D – ACO Initiatives to Address ACO Model Quality Measures Measure Current ACO Activities Underway Planned ACO Activities Underway Goal #1: Increase Access to Primary Care Percentage of adults with usual primary care provider All of CHAC's FQHC participants are NQCA PCMH recognized. NCQA's PCMH 2014 standards require FQHCs to have practices in place to ensure that patients are assigned a PCP (see Standard 2A: The practice provides continuity of care for patients/families by: Assisting patients/families to select a personal clinician and documenting the selection in practice records; and monitoring the percentage of patient visits with selected clinician or team.) CHAC has also required that other participants (VNAs, and CMHCs) should have practices in places to ensure patients are assigned a PCP. Plan outreach activities to connect with "attributed but not seen" patients. FQHCs will continue with activities that fulfill PCMH requirements related to PCP assignment. Promote best practices of VNAs, CMHCs, and Designated Agencies to ensure patients are properly assigned. Medicare ACO composite of 5 questions on Getting Timely Care, Appointments and Information Annually, CHAC completes the CAHPS survey as a condition of its contract with Medicare. The data from the survey are reviewed across the CHAC governance entities (Clinical Committee, Board, and the Consumer Advisory Panel) to identify set ACO-level goals and best practices. Same activities planned for next year Percentage of Medicaid adolescents with well-care visits Not applicable. Not applicable. Percentage of Medicaid enrollees aligned with ACO Not applicable. Not applicable. Goal #2: Reduce Deaths Related to Suicide and Drug Overdose Deaths related to suicide CHAC has implemented ACO-wide efforts that focus on depression screening that include questions related to suicide risk. Many of the CHAC participants are engaged in regional/local efforts as well including expanded use of the PHQ2/PHQ9 screenings. At least one CHAC participant is engaged in a Zero Suicide pilot. CHAC monitors these Same activities planned for next year