Quality & Efficiency - ACE Program
Between the Medicare Shared Savings Program, accountable care arrangements and payer relationships, it is not uncommon for physicians to be faced with upwards of 200 quality outcome measures in their daily work.
The goal of the Achieving Clinical Excellence® (ACE) Quality & Efficiency program is to streamline these disparate guidelines into a singular roadmap of high-impact Value Based Measures. The LVPHO leadership team oversees the program to help member physicians efficiently achieve common measures and, in turn, earn points, which equate to financial incentives. Outcome measures vary by specialty and point distribution is segregated into Primary and Specialty Care, so performance can be evaluated against that of fellow member physicians within a given primary or specialty care group.
To view the 2016 ACE Value Based Measures, click here.
Standard Score Opportunities: An incentive distribution may be available for both primary care and specialty care physician groups. The data collected through Populytics will generate scores in quality and efficiency. The scores are compared to national benchmarks, then to your specific peer group to establish a target. The target threshold is used to incentivize practice performance through ACE. These include:
-Exceeds Threshold: Provider/Practice will receive full withhold plus an incentive based on performance compared to national colleagues.
-Exclusion Threshold: Provider/Practice will receive full withhold reimbursement
For purposes of incentive distribution, a practice or provider may be excluded for the following reasons:
- Low volume of episodes
- No measure to assess provider or practice - Providers/Practices may create and submit own plan for approval
- No Choice Plus and/or Aetna, Cigna participation.
-Surrender Threshold: Provider/Practice will receive full withhold minus 5% of the dollar value.
Bonus Score Opportunities (PCP only): Physician groups may earn bonus points through achieving benchmark scores for certain utilization measures. Bonus Score opportunities may become Standard Score opportunities in future ACE cycles.
Trial Measure Opportunities (PCP only): In an effort to remain progressive, Physician groups may see a trial measure. Trial measures have no point value. After completing an ACE cycle, trial measures may become Bonus Score opportunities and/or Standard Score opportunities in future ACE cycles.
To request the latest list of ACE Quality & Efficiency measures and point values for your specialty, contact a Physician Advocacy Liaison:
Wayne T. Stephens, Physician Advocacy Liaison, LVPHO/Valley Preferred
Joe Candio, Jr., Physician Advocacy Liaison, LVPHO/Valley Preferred
Michael Makela, Physician Advocacy Liaison, LVPHO/Valley Preferred