The world of Accountable Care Organizations (ACOs)

Owing to the models that ACOs operate with, they need to identify the right sources for useful data, aggregate it and find meaningful insights across a lot of different areas. These areas span across care provisioning, cost management, contracting, utilization, performance and quality. As the objective is to ensure savings through effective preventive care, it is important for them to gain access to data that resides within their network and outside. Below are a few areas of relevance for the management team of an ACO enterprise.

Contract Management

It is imperative to know per patient per month performance, utilization metrics and their performance on all 33 measures for ACOs to gain visibility into their performance. This visibility into the data will help them negotiate their contracts with the payer better.

Network Management

ACOs need to optimize their composition and ensure that patients do not venture out of their network. Here, they should understand the referral patterns, sources of out-of-network payments, patterns in the health of populations, predict demand for services and optimize their physician networks accordingly.

Care Management

They must follow the care transitions, re-admissions, comprehensive discharge planning, and notify and educate patients in a timely manner.

Quality

The financial success of an ACO is tied to its performance on the quality indicators prescribed by the CMS. Unlike other programs where a dip in the performance gets penalized in the form of penalties at the end of the year, ACOs are at a greater risk as their business model ties their ineffectiveness to their finances more closely. Hence, it becomes imperative for the ACO leadership at all levels to monitor their performance on all 33 measures and ensure that they address areas impacting their performance.

Data challenges faced

Given the breadth of responsibility that ACOs bear, the amount of data they need to analyze is huge. As the focus is on the whole continuum of care for each patient, they need the complete picture in order to be effective. This means that they need data from Primary care settings, specialty care, Labs, Pharmacies, Payers, Long term care facilities, behavioral health, home health, hospices, patient surveys among other similar sources. To add to the challenge it isn’t unusual to find an array of systems within the ACOs. Given the number of hospitals, practices and other facilities that form an ACO enterprise, it is difficult to have one single system. As a result, ACOs find themselves dealing with many different EHRs within their network and end up exchanging data with those outside.

As the number of systems exchanging information increases, seamless data flow within the enterprise is a dream at best. The IT teams of ACOs struggle to make sure that nothing breaks in the system. As not all these systems were designed to facilitate exchange of data, the mechanisms employed to get access to the data from this array of systems differ. In some cases this data is made available through APIs, CDA documents or the more traditional HL7 interfaces.

More often than not, this data is aggregated in data warehouses periodically and then made usable through data marts. Maintenance of infrastructure to ensure extraction of this data is a task that requires constant monitoring as the data quality may not be consistent across the source systems.There are numerous occasions when these HL7 interfaces break and the data flow stops.

While the ACOs face all these challenges on a daily basis, there are also added pressures of cost and time. There is a need to achieve these objectives faster, better and cheaper while ensuring that the quality isn’t compromised.

As the view of the data in each of these systems is different, one needs to put an effective data governance framework in place to ensure that this data is usable. The motivations and perspectives of end users differ based on their role. The same data may have different meaning for a case manager and a CFO in an ACO. While the data in question may be clinical, financial, operational or quality related, the way it is interpreted and the actionable derived from it may be different for each end-user. Hence there is a need to analyze the same data differently depending on the objective of the end-user. This requires an understanding of the persona and perspective. Analytics teams in ACOs are constantly chasing these objectives to satisfy this myriad of end-user needs.

While the ACOs face all these challenges on a daily basis, there are also added pressures of cost and time. There is a need to achieve these objectives faster, better and cheaper while ensuring that the quality isn’t compromised.

While the IT teams grapple with the challenge of making data available from all these systems available to the users at the right time, there are perpetual and frequent requests from the management to make sense of this data. Even though most solutions aim to fulfil the need for a variety of reports, there are frequent occasions when end-users need adhoc reports. The number of people in an ACO requiring these ad-hoc reports keeps the analytics teams busy. The choice of tool for visualization can be instrumental in addressing such needs. However, not all ACO enterprises are lucky when it comes to powerful visualizations. As a result, the IT teams are stretched and the end-users spend too much time making sense of the data.

While the ACOs face all these challenges on a daily basis, there are also added pressures of cost and time. There is a need to achieve these objectives faster, better and cheaper while ensuring that the quality isn’t compromised.

Write to Us
Cookies help us deliver our services. By using our services, you agree to our use of cookies Privacy Policy Got it!