Sharing is Caring: The success mantra for ACOs

In the last edition, we discussed the challenges ACOs face and that the solution wasn’t spending more money. An ACO that does not use robust and resonant technologies is like a car without engines. It will barely work, the ride won’t be comfortable for either the rider or the companion and there is no guarantee they’ll make it to the destination.  

When we talk about an individual hospital, there is a lot of data in the form of clinical, claim, financial, genomic, and a lot more. Now, multiply it by the number of care providers collecting the same type of data with different “black box” models and try to imagine ACO managing that data “efficiently” with technologies developed in 1950’s. This data is a massive opportunity for an ACO with newer age technologies. With such technologies an ACO can perform risk monitoring, stratification, clinical analytics, financial analytics and eventually provide cost-effective and quality care.

Why is care management necessary?

Theoretically speaking, one of the most important aspects of providing a service is the feedback mechanism, which helps in improving the quality of service. Care does not stop after a patient is discharged from a hospital, post episode care is also vital to prevent infections, allergic reaction or any other issues that might occur. This goes the other way too, i.e., the same background check has to be performed before prescribing medications.

One of the most important things the ACOs have to realize that care can be cost effective only when patient-centric care is targeted. This seems a bit abstract, let me elaborate. If an ACO decides to pay more attention to the 1% population, which is responsible for creating 30% of the cost, then timely engagement can reduce a lot of risks and thereafter save a lot of money!

What is needed?

A thorough research to form a strategy! ACOs need to analyze all the models, potential revenue, the risks involved, the process of beneficiary assignment, services and incentive for quality. For this ACO will have to conduct both external review and internal review. External to identify the opportunities and threat. For example, a comprehensive study of communities and the attached ACOs. Internal review to make adjustments according to the trend.

How to fulfill these needs?

All these things cannot be done manually. In fact, the possibilities are endless once ACO has the apt technology. It’ll automatically direct the ACO in the  right direction. Here is a checklist of necessary technologies:

1.  Near Real Time Data Integration: An ACO deals with a large number of patients and every patient has a unique medical record. When the records of all the patients are combined, a comprehensive analysis of financial and clinical data could be done. This can not only help in improving the cost of care but also prove beneficial in uncovering new opportunities. For example, if the ACO finds out that for a particular treatment or service, patients are going ‘out of the network’, it can work on a strategy to add that service to the network.
2.  Interoperable Data Standards: Whenever a patient with a medical history goes to a certain provider for treatment, the provider faces a dilemma. Whether the previous treatment was done by a specialist or not? What kind of medications were prescribed? What were the past test results? Medical record of patients is like Holy Grail for providers. An ACO can provide better care only if gets to retrospect and utilize the treatment history to its advantage.
3. Advanced and Predictive Analytics: The biggest advantage of having robust technology is that it empowers ACOs with analytical prowess. If an ACO is capable enough to perform a drill down analysis of patient reports, it can offer 360-degree care. For example, if a person has been diagnosed with diabetes, he could be visited earlier or hospitalized to reduce the cost of care. It can also leverage the data to find the patients who have been are suffering from chronic disease, but have avoided physician visits for a year or more and hence lead to preventive care interventions and better care outcomes.
4.  Near Realtime Care Coordination: Imagine if you had a health coach that suggested a cholesterol checkup 10 days before you could have actually suffered a stroke. Wouldn’t you thank the person for life? Such automated interventions by health coaches for better healthcare delivery will really transform how ACO’s can add value. Timely engagement with health coaches can mitigate the risks and care managers can also make sure the compliance of health plans, scheduled visits, medication, etc.

Hence the broader schematic of Population Health Management, that includes, data, measurement, analytics, and engagement can be tremendously beneficial to the entire healthcare ecosystem.  

Coordinated care is a win-win situation

Many ACOs have profited after implementing the various technology solutions. As of 2015, the average of national savings for an ACO per beneficiary stood at $413, which is almost half the average savings of top 10 ACOs. The highest was $1679 per beneficiary for RGV ACO Health Providers. So, what exactly did these 10 did differently?

To answer that, I’ll tell you the story of one such ACO, which saved a whopping $22 million in shared savings program. It was among the 29 ACOs which earned from the shared savings program in the very first year. ACO declared that the key to success was patient-centered care. According to the ACO, as much as 25% could be lost is the patients are dissatisfied. They earned this much by increased the outreach programs, timely care, better patient experience (by staffing, extended hours, etc.), health education, regularized updates on the health status of patients and much more.

Such improvisations in care delivery are not possible without apt technology in place. Meeting the CMS mandated 33 quality measures requires smart work. Look at this way, just by being proactive in engaging patients to visit and preventive screening covers 11 out of 33 measures.

Evolutionary process

Accountable Care is a revolutionary concept. It transforms the entire care ecosystem into a learning care system. The implications of the success of the ACO model can be huge and technology is going be at the core of this success. So, to all the revolutionary care transformers – take the first step – embrace the future – and let’s create a better tomorrow.

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