Accountable Care Organizations (ACOs) can transform the regulatory requirements for reporting on CMS benchmarks into a strategic opportunity to enhance care quality. Leverage data from your reporting to gain actionable insights that drive improvements in patient outcomes, operational efficiency, and financial returns. Learn how.
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Fifteen years ago, Congress established the CMS Innovation Center and introduced alternative payment models (APMs) that fundamentally reshaped healthcare delivery. These payment models have helped shift focus toward improving clinical quality for all patients, including Medicare beneficiaries, aiming to enhance patient care and reduce waste and inefficiencies across the board.
The Medicare Shared Savings Program (MSSP) is one of the country’s largest APMs. In 2023, MSSP yielded its largest net savings of $2.1 billion since its inception over a decade ago. That momentum shows no signs of slowing as the Centers for Medicare and Medicaid Services (CMS) has set a goal to move everyone with traditional Medicare into an ACO by 2030.
Along with traditional fee-for-service payments, ACOs participating in Medicare’s voluntary, value-based care payment models like MSSP can qualify for bonuses by reducing expenses and improving care for their patient population.
However, for Medicare ACOs to secure bonus payouts, hospitals and healthcare providers in their network must collaborate to meet quality benchmarks and spending targets. While keeping an eye on costs, these ACOs must improve care across the continuum, reducing care variation, improving care coordination, and minimizing unnecessary care.
Consequently, it is essential for ACOs to collect and analyze data on organizational performance, individual provider effectiveness, and the health status and outcomes of patients.
Medicare ACOs are subject to quality benchmarks set forth by CMS, which may include how well they perform across clinical domains and in promoting interoperability. An ACO’s final composite score depends on how well it performs across those domains. This score determines how much money the ACO will save and share.
According to CMS, compared to other types of physician groups, ACOs have scored better on many quality measures, including diabetes and blood pressure control, cancer screenings, and depression screening and follow-up. ACOs also continuously demonstrate clinical quality improvements over time.
In the performance year 2021, CMS encouraged ACOs to report its quality measures through the Alternative Payment Model Performance Pathway (APP), a simplified reporting option. This directive presented ACOs with many opportunities to utilize data to enhance clinical, operational, and financial performance.
Yet, APP is no longer an option for ACOs. In the performance year 2025, CMS initiated a newer reporting mechanism: the Advanced Alternative Payment Model (APM) Performance Pathway Plus Quality Measure set (APP Plus).
While APP Plus data reporting offers tremendous potential for driving clinical quality improvement, ACOs face significant hurdles in fully leveraging data’s power.
Challenges may include data complexity, gaps in data accuracy and completeness, and limited resources for advanced analytics, which often prevent organizations from turning raw data into actionable insights and achieving meaningful improvements.
More specifically, ACOs struggle with surmounting the following hurdles:
One of the biggest obstacles is fragmented data and analytics systems that fail to provide an integrated view of organizational or clinical performance. Claims data might tell one story, while clinical data tells another. Without a cohesive approach to data integration, Medicare ACOs risk overlooking critical care gaps or performance trends that could undermine clinical quality improvement efforts.
Even when data from different systems is available, a lack of standardization contributes to limited care coordination, incomplete patient data, or over-utilization of healthcare services, such as duplicative tests and procedures. APP Plus data must be normalized to ensure that everyone in the organization has access to complete data sets and accurate reporting metrics.
Without standardized definitions and formats, organizational leaders and healthcare teams may interpret the same data differently, leading to inconsistent strategies and misaligned priorities, which ultimately impact shared savings.
The sheer volume of data can overwhelm Medicare ACOs, particularly those with limited data management and analytics resources. Sifting through large datasets to find actionable insights is time-intensive and prone to human error. Gaps in data accuracy and completeness further complicate analysis, undermining trust in the insights and limiting their usefulness.
These challenges highlight the need for advanced data and analytics tools and strategies that go beyond helping ACOs achieve regulatory compliance and meet benchmarks. Such tools must enable ACOs to harness APP Plus data for continuous quality improvement.
To advance clinical quality improvements by leveraging real-time analytics and strategic reporting, ACOs must seek to attain the following from their data and analytics ecosystem:
Fragmented systems often prevent Medicare ACOs from gaining a unified view of performance and single source of truth. The Health Catalyst MeasureAble™ application, powered by the Health Catalyst Ignite™ Data and Analytics platform, integrates quality data into a single and scalable platform.
This seamless integration eliminates silos, ensuring that ACOs can identify care gaps and trends across providers, departments, and locations. By providing a comprehensive view of performance, MeasureAble enables more strategic and informed clinical quality improvement efforts.
The lack of data standardization often creates misalignment across teams within an ACO. MeasureAble solves this challenge by utilizing Ignite’s lakehouse architecture. This architecture standardizes and normalizes data, ensuring all departments and stakeholders can capture, manage, and process data for analysis. This creates a shared understanding that fosters collaboration and efficient decision-making.
ACOs must streamline and simplify the management of ever-expanding datasets. MeasureAble simplifies this complexity through Ignite’s advanced data architecture, efficiently processing large datasets for accuracy and completeness. MeasureAble’s intuitive dashboards make these insights accessible to all team members, allowing ACOs to act on critical information without requiring extensive technical expertise.
Enhancements in data standardization, analysis, and streamlined management can significantly advance ACO goals. Indeed, the more sophisticated aspects of handling data and leveraging it for insightful analysis, achieved through MeasureAble and Ignite, can result in tangible outcomes, as illustrated in the following case studies.
Baptist Medical Group and Baptist Urgent Care sought to enhance primary and preventive care screenings. Utilizing Health Catalyst MeasureAble and the Health Catalyst data platform, they monitored performance metrics, identified care gaps, and improved pre-visit planning.
Workflow changes based on data insights enabled real-time visualization of impacts on care gaps and quality performance. As a result, Baptist Medical Group achieved a 96 percent quality score with 100 percent performance in four measures. Baptist Urgent Care reached a 79 percent quality score with 100 percent performance in five measures.
This case illustrates how ACOs can leverage benchmarking to compare against peers and identify best practices for improvement.
Baptist Health Care also sought to increase its shared savings and needed high-quality data and analytics to do so. Baptist faced challenges with low-quality scores and limited oversight from its previous monitoring tool, which provided data without actionable insights.
Process changes took weeks to reflect in scores, hindering their ability to evaluate outcomes effectively. To address these issues, Baptist replaced its outdated system with MeasureAble, gaining access to robust analytics that enabled timely reporting and identification of improvement opportunities for enhanced performance.
This yielded significant returns, including a composite score of 92.94, which placed them in the exceptional performance quartile, qualifying them for a performance bonus and increased revenue.
Community Health Network (CHNw), committed to ensuring patients received appropriate primary and preventive care, felt burdensome documentation processes in the EHR made it difficult to improve performance and close care gaps.
They leveraged MeasureAble in their EHR to give providers access to critical patient information directly within their workflow, significantly reducing the time spent on manual data searches. As a result, they were able to focus more on delivering appropriate primary and preventive care, which improved value-based performance.
Built on Health Catalyst Ignite™ Data and Analytics ecosystem, MeasureAble provides ACOs with a reliable foundation to address fragmented systems, lack of standardization, overwhelming data volumes, and the need for real-time insights, transforming APP Plus data into fuel for ongoing performance enhancements.
An advanced data analytics platform and MeasureAble enable ACOs to analyze data in real time and leverage predictive analytics to identify care gaps, act on emerging trends, and anticipate patient and population health needs.
As such, APP Plus data reporting has become a roadmap for achieving healthcare excellence and meeting CMS’s goal of improving primary care for patients while keeping healthcare spending in check.
As CMS continues to shape its APM programs through federal rulemaking, ACOs can capitalize on these value-based care payment programs to transform their approaches to delivering care to all patients.
By leveraging advanced tools like Health Catalyst’s MeasureAble, powered by Ignite, ACOs can overcome challenges such as fragmented data and analytics systems, data inconsistency, and limited analytics resources. Real-time insights and predictive analytics allow organizations to act with foresight and precision, addressing care gaps and improving outcomes while reducing costs.
The future lies in a data-driven and proactive approach that anticipates patient needs and delivers care tailored to populations. When utilized effectively, APP Plus data becomes a cornerstone for creating an efficient, responsive, and quality-centered healthcare system.
Ready to see how our solutions can help your organization improve care and cost savings? Schedule a demo today or connect with our team to discuss how we can simplify your reporting processes and increase shared savings.
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