With an increasing emphasis on value-based care, Accountable Care Organizations (ACOs) are here to stay. In an ACO, healthcare providers and hospitals come together with the shared goals of reducing costs and increasing patient satisfaction by providing high-quality coordinated healthcare to Medicare patients.
However, many ACOs lack direction and experience difficulty understanding how to use data to improve care. Implementing a robust data analytics system to automate the process of data gathering and analysis as well as aligning data with ACO quality reporting measures.
The article walks through four keys to effectively implementing technology for ACO success:
1. Build a data repository with an analytics platform.
2. Bring data to the point of care.
3. Analyze claims data, identify outliers, including successes and failures.
4. Combine clinical claims, and quality data to identify opportunities for improvement.
This report is based on a 2018 Healthcare Analytics Summit presentation given by Joan E. Valentine, RN, MSA, Executive Vice President Visiting Physician Association, US Medical Management, and David C. Vezina, MBA, Chief Information Officer, US Medical Management.
Accountable Care Organizations (ACOs) are an important business model of today’s value-based care environment as they strive to provide quality, efficiency, and improved healthcare outcomes for patients. In an ACO, healthcare providers and hospitals come together with the shared goals of reducing costs and increasing patient satisfaction by providing high-quality coordinated healthcare to Medicare patients. The goal, according to CMS, is to ensure that “patients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.”
The idea behind an ACO is that if providers are incentivized to improve the health of their patients over providing a large volume of services, the cost of care will decrease. When an ACO succeeds at delivering high-quality care and reducing healthcare spending, the ACO shares in the savings achieved for the Medicare program.
What anyone who has participated in an ACO knows is that it is not always easy to get started. These organizations often lack direction, and it can be difficult to understand how to use data toward actionable interventions in improving care. Integrating real-time data and analytics into provider workflows can ensure patients receive the appropriate primary and preventative care, improve ACO Measure performance, and save Medicare money.
Participants in both the ACO program or Medicare Shared Savings Program (MSSP) are subject to a number of Medicare quality reporting requirements and performance initiatives, such as the Merit-based Incentive Payment System (MIPS). An ACO’s quality composite score is based on the performance of MIPS Group Practice Reporting Option (GPRO) best practice preventative care and primary care measures. ACO participants may receive as high as a four percent upward or downward payment adjustment based on their quality composite performance. ACOs are successful when the organization improves patient satisfaction, improves care coordination, and reduces cost.
ACOs are required to demonstrate quality through four domains:
Participation in ACOs has been steadily growing since 2012. As shown in Figure 1, more healthcare providers and hospitals are participating in ACOs each year and their average overall quality scores, as well as performance payments are also rising.
Even though the accountable care organization model continues to grow, implementing such a model is no easy task. Below are just some of the common challenges to successful implementation:
Transforming from a transaction-based system to a pay-for-performance based systems is a difficult process. Having the right technology and investing in that technology can help smooth the path forward for ACOs.
Steps to effectively implementing that technology might include the following:
Successful participation in the ACO program involves a lot of factors, beyond just technology. Other insights from successful ACO models include the following tips for success:
Healthcare organizations and providers increasingly need to focus on the health of patient populations, requiring care coordination and teamwork across specialties and organizations. A successful ACO model means the elimination of siloed views in favor of a more expansive and collaborative model of care delivery. In order to be successful, an ACO must address these challenges by leveraging a robust analytics system to automate the process of data gathering and analysis and aligning data with ACO quality reporting measures.
Would you like to use these concepts or share with a colleague? Download this presentation highlighting the key main points.
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