ACO Success Depends Upon Comprehensive Data Management
Even though devising various data integration and analytics strategies are key to operating an Accountable Care Organization (ACO), many providers are finding that the new payment model also requires some major changes in business strategies as well as leadership.
Because the financial success of ACOs is so dependent upon varying patient decisions, such as medication adherence or staying within the ACO for most of their care, these new organizations are eagerly searching for better strategies for communicating with patients—as well as getting on the same page internally, says Bill Leander, Vice President, Strategic Advisory Services at Santa Rosa Consulting, Franklin, Tenn.
“The most pivotal issue that pioneer ACOs are encountering is a fundamental shift from thinking about care delivery from the inside out to do more outside in- more patient centric,” he says. “The scary part is that ACO success is determined by the 99% of the care that happens beyond their control – patient behaviors, decisions and choices at home and beyond any walls of traditional care settings – and not the 1% that they do control. So ACOs have to go beyond patient engagement. They have to excel at patient ownership.”
Santa Rosa plans to conduct a focus group with members of the College of Health Information Management Executives (CHIME) at the HIMSS13 Annual Conference and Exhibition to specifically discuss ideas and strategies for ACO data management and analytics, a major component of successful ACO planning and design. The discussion will center on the data management requirements and challenges that directly impact an ACO’s ability to shift to risk-based payments models, minimize ACO leakage, and improve coordination of care and ultimately population health management.
Some ACOs, however, already have identified some best practices. For example, ACO leaders must not only be able to focus on improving patient communication, but also on aligning all providers behind the new movement. Additionally, they must internalize insurance industry acumen, shifting their focus to new metrics and performance measures, rather than just evaluating how the new strategy is affecting their own hospital or practice’s bottom line, says Mike Kovner, Director, Strategic Advisory Services at Santa Rosa.
Other success strategies include creating consistent metrics on how both clinical and financial data, episodes of care and care processes, both at the point of care and over periods of time will be measured after the ACO has been up and running for a while, Kovner adds.
“Some ACOs have set up elaborate dashboards with hundreds of quality measures but we’ve heard that’s just too much,” Kovner says. “They’re much more effective if they focus on some specific quality targets that are most impactful. If they limit them to ones that they can count on one hand, then medical leadership can instill just a handful of quality measures into the heads of caregivers rather than hundreds.”
While ACOs are still relatively new, a few already have hit some pitfalls. For example, one ACO decided to accept a risk contract with a commercial health plan before determining where its exposure was and ended up running into some trouble quickly because it hadn’t solidified its risk share arrangements or metrics.
“This might work for ACOs that have a large development fund, but not for others that are expecting a more predictable return,” Kovner says.