"Not only was the available information limited to claims but it was retrospective," IDC wrote. "It was virtually impossible for physicians to understand their own practice patterns and determine how their performance needed to be modified. Most discussions between payers and providers resulted in arguments about the accuracy and timeliness of the data."
Data - much more readily available than it was 20 years ago - will lead to a better fate for the ACO than the HMO, IDC said. Healthcare organizations are making needed investments in analytics and warehousing technology, not to mention staffing. They're also paying particular attention to population health management, especially for patients with chronic conditions or those participating in wellness programs to better manage their health.
To do this, the Premier Inc. survey found, hospitals partner with a bevy of entities, from local public health departments and nearby large employers to payers (public and private) and external providers.
With ACO Analytics, 'Getting Lost in the Weeds' All Too Easy
Pioneer, MSSP or otherwise, ACOs face a variety of technology challenges. These include electronic health record (EHR) adoption, clinical systems interoperability and patient engagement - but data analytics is the arguably the biggest obstacle of all.
It's great to marry payer and provider data to get longitudinal, real-time analysis on a patient, but it's "incredibly complex and complicated," and simply foisting that information on physicians is "adding to a day that has no time," says Michael Gleeson, senior vice president of product strategy for Arcadia Solutions. (Gleeson spoke at the recent Strata Rx conference.)
Providers need to build trust in order to build improvement, Gleeson says. That means examining physician workflows - which admittedly involves "weird Big Brother stuff" - to see how high-performing doctors interact with clinical systems. Only then will an organization understand when it's best to put data in front of a physician.
Then there's the matter of how you put data in front of a physician. EHR systems are complicated even without the inclusion of clinical decision support, HIE and ACO management modules. There's also the temptation of "getting lost in the weeds," Gluck says, of "letting perfect be the enemy of the good."
To combat that, Heritage Provider Network built its own Web-based ACO management system to tracks individual patient care plans and quality measurements and put them in the context of how treatment is progressing and how much it's costing. Echoing Gleeson, Gluck says a fancy complicated analytics program that tries to be "everything to everyone" isn't helpful for time-starved physicians who don't like complicated software platforms.
For Heritage Provider Network, ACO success is a matter of picking the proverbial low-hanging fruit (reducing hospital readmissions) or the healthcare services that aren't necessarily offered elsewhere (diabetes management) and using analytics to make the most of those initiatives.
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