Beaconology for beginners: A chat with ONC's Aaron McKethan
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“The basic premise is that there is no one particular thing that if implemented at a community level would produce effective, sustainable quality cost improvements,” McKethan said.
In addition to the 15 communities chosen earlier this year, HHS announced last week the two final communities to participate in the Beacon Community Program: Detroit and Cincinnati. Under the program, the Greater Cincinnati HealthBridge in Ohio and the Southeastern Michigan Health Association (SEMHA) in Detroit will receive $13.8 and $16.2 million, respectively, over three years.
Cincinnati and Detroit were awarded Beacon Community status on the same criteria as the original 15 communities, including performance improvement goals, the vision of the community over the course of the program, clarity around community-specific goals that builds on an existing IT infrastructure and the sustainability of performance improvements over the long haul, said McKethan.
For example, in Cincinnati, the Beacon Community Program funds will enable HealthBridge to build on its health information exchange (HIE) capabilities to improve patient care, McKethan said. This will require HealthBridge to invest in care managers and take additional steps to access data and use them in ways that haven’t been done, he said.
In addition, the Cincinnati Beacon Community wants to sustain its efforts by showing major commercial payors in the region that the HealthBridge program adds “considerable value” to the bottom line of improving healthcare delivery quality and slows the growth of spending for delivery of care, according to McKethan.
Healthbridge hopes to engage Medicare, Medicaid and the major private payors during and after the Beacon Community Program to pay into the system on the basis of quality and value instead of the basis of volume and intensity of services. Hopefully, this will be achieved with a demonstrated track record of improvements in both quality and value, McKethan said.
“One of the critical features of the Beacon program is the belief that producing consistent performance measures at the community level--cost, quality and population of health--can be helpful at the local level to help physicians know on an ongoing basis if their interventions are working and how they might be changed as they go forward,” he said. “Achieving quality improvement locally is an iterative process.”
Beacon Communities are now establishing a baseline of performance measures data to pinpoint their starting point and to track their communities’ improvements. All program members will be recording performance measures on a quarterly basis to understand how their efforts are translating to better care, and will send those results to each other, their community partners and to ONC as a way to evaluate their project, said McKethan. ONC will report on the performance measures in the future, he said.
Many of the Beacon programs focus on using IT to improve care for chronic conditions such as asthma, heart failure and diabetes. McKethan expects Beacon Communities to develop performance measures for such things as avoidable hospital readmissions for patients who have been hospitalized for chronic conditions, or emergency room utilization.
Other measures might include smoking cessation rates or rates at which smokers are offered cessation therapy, he said.
“We’re going to release the measures each community is collecting or reporting on in a month or so, once they're finalized, and that will be an open, transparent process,” said McKethan.
In addition, ONC is seeking a scientifically valid third-party evaluator of the Beacon Community Program, and will release an evaluation contract for potential bidders in a few weeks, he said.
After three years, expansion of the program would require further congressional action. Although “we are not anticipating [further congressional action to extend the program], we would be delighted for more communities across the country to take similar steps. We are prepared for other communities to receive benefits from the program even if we don’t expand from the formal program,” concluded McKethan.
a scientifically valid third-party evaluator of the Beacon Community Program