Information - The key to success for accountable care organizations

According to the Centers for Medicare and Medicaid Services, the goal of Accountable Care Organizations is “to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” The healthcare reforms are incentivizing industry players to improve the population’s health and deliver quality care at low cost. Therefore, the success of an ACO is determined by its ability to deliver financial and clinical outcomes.

There is an immense amount of data available to ACOs. And information is the single most valuable currency they can leverage to create value and competitive differentiation. The consumable data of patients, providers, treatment outcomes and clinical best practices can be integrated and analyzed to improve care and reduce cost. Insights from population analytics, care analytics and performance analytics can play a key role in helping ACOs achieve their goals.

Population analytics provides a longitudinal view of population, patient, and provider to identify opportunities for improvement. Population profiling, risk stratification, and referral and utilization patterns can be studied to identify gaps in chronic and preventive care. Studying sub-populations can help identify high-risk members and predict the need for care. This can help ACOs define their intervention strategy.

Care analytics on the other hand, helps in evaluating performance gaps on various parameters ranging from patient condition to provider. For example, in the case of a patient readmitted to the hospital, the care plan, patient compliance with treatment plans and readmission rates against benchmarks, can all be measured and analyzed, to derive a modified clinical workflow with better decision-making. Analytics can also help to evaluate alternative treatments. Care coordination activity needs an analytics system that can generate real time actionable alerts to providers and care managers based on a patient’s vital data.

Reporting of key performance indicators like care outcome, provider and financial performance, are also important for an ACO. For instance, “Are diabetic patients being administered specified tests at predetermined intervals?” Or, “How is the ACO performing in terms of profitability?” Performance analytics provides a way to measure progress and outcome.

While ACOs understand the importance of data and analytics, long implementation times and the high cost of implementing a big data analytics strategy does prove challenging for most providers. ACOs must also define a data strategy, understand which data to track and analyze, select and implement the optimal analytics solutions and invest in business-as-usual services. These activities require a certain level of expertise. ACOs should therefore partner with a capable IT organization, on a profit sharing model, that can assist in achieving the required outcomes.

Have you experienced the impact of data & analytics in delivering accountable care? How do you think technology intervention can help ACOs deliver better care? Do share your experiences here.

About the Author

Sangita Bhattacharyya is a Sr. Practice Manager with 11+ years of experience in IT Solution Consulting, Core Claim Admin Platform implementation and Business Optimization service across public and private Health Insurance. Sangita is a AHIP certified Managed Healthcare professional (MHP) and PMP (PMI). She is responsible for conceptualizing and building domain led solutions in the areas of Digital Health ( Mobility, Social and Analytics) , Facets and Care Management.

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