When data and analytics are leveraged to identify the most vulnerable patients, ACOs can provide innovative care delivery through a data and people-focused mindset. Advanced analytics will generate value improvements in care quality and help drive millions in Medicare shared savings.
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This article is based on a healthcare conference presentation by Megan Romine, DO, MHA, FACP, Interim Chief Executive Officer, UnityPoint Accountable Care, and Mandy Abbas, MPA, Analytics Manager, Value-Based Care, UnityPoint Health titled, “Advanced Analytics and Innovative Care Delivery Helps Drive $31M in Shared Savings.”
As healthcare expenditures reach staggering proportions, alternative payment models leveraging advanced analytics are gaining popularity. One solution is risk-sharing arrangements, a value-based care model where participants share healthcare delivery’s profit or losses. The model utilizes a set of shared performance metrics and incentivizes payers, providers, and healthcare systems to collectively improve care quality and lower medical costs.
Accountable Care Organizations (ACOs) are prime examples of performance-based contracts. ACOs frequently unite various healthcare providers and services within a specific region, such as hospitals, clinics, mental health institutions, and home care services. This whole-systems approach allows patients to access care conveniently and streamlines data collection to enhance care coordination and intervention decision-making. Performance monitoring, collaboration, and data sharing are essential for these arrangements to thrive.
Indeed, high-quality data is the foundation of an ACO's success. It supports performance measurement, care coordination, risk stratification, decision-making, financial management, and continuous quality improvement efforts. With accurate and reliable data, ACOs can effectively manage patient populations, improve outcomes, and achieve value-based care goals. Absent a robust ACO analytics platform, conversely, high-volume electronic patient data can overwhelm medical providers, resulting in oversights that impact patient care.
Utilizing a data-driven analytics platform with meaningful data and analytical capabilities also makes it possible to pinpoint clinical opportunities that could help engage patients more prone to expensive medical complications. This, in turn, leads to the development of innovative outreach and care delivery methods that ultimately reduce medical expenses.
The participants of the ACO model have established a strong record of demonstrating their ability to shift from transactional care to value-driven patient care. According to recent figures, over 525,000 clinicians provide care to more than 10 million Medicare beneficiaries through the Medicare Shared Savings Program. CMS announced that the Medicare Shared Savings Program, through its work with ACOs, saved $1.66 billion in 2021 compared to spending targets. Thanks to the program's success, CMS will enroll all individuals with Traditional Medicare in an accountable care partnership by 2030.
High-value healthcare data analytics platforms support ACOs in critical areas. Here's how:
By utilizing data and analytics to identify patients who are most likely to benefit from coordinated support, ACOs are achieving success in risk-based contracts and simultaneously improving the well-being and satisfaction of their patients.
It is essential to articulate clear success measures and tailor the messaging to the ACO stakeholder, whether clinicians, quality staff, payers, patients, executive sponsors, or community partners.
Therefore, highlight healthcare data analytics and technology within ACO partnerships. Illustrate how the aggregation and analysis of data foster evidence-based decision-making, performance measurement, and continuous improvement. Also, discuss how data insights inform care strategies, identify gaps, and propel targeted interventions.
More specifically, use access to advanced analytics to demonstrate wins in disease prevention, early detection, and chronic disease management, identify top-performing facilities and providers, and acknowledge their achievements. Doing so encourages other providers to assume responsibility for the quality and cost of care delivered to patients so they can share in the financial reward.
Meanwhile, highlight how data insights catalyze opportunities for collaborative learning and best practice exchange among ACO partners. Discuss how the ACO ecosystem facilitates knowledge sharing, peer-to-peer collaboration, and the dissemination of successful care models due to access to quality data and analysis.
While healthcare leaders recognize the utility of data and analytics solutions, continuous investments in cutting-edge technologies empower them to harness data's full potential. It begins by showcasing the promise of risk-sharing models in the delivery of medical care.
Enterprise analytics has emerged as a critical tool to help healthcare organizations extract clinical, operational, and financial insights from large-scale data sets and gain a competitive advantage. However, many hospitals and healthcare systems still view analytics as a way to generate reports or dashboards without fully leveraging its problem-solving potential. A high-value data ACO analytics platform that utilizes predictive modeling can arm stakeholders with the ability to analyze large volumes of data and make well-informed decisions quickly. To be sure, healthcare data analytics solutions enable the following:
Healthcare IT software companies play a crucial role in helping ACOs integrate advanced analytics platforms. The best in their field offer technical expertise and knowledge and understand the complexities of healthcare data, interoperability, security, and compliance requirements.
In many respects, the steady rise of value-based care performance models that utilize high-value data hinges on choosing the right technology partner. Selecting a health IT solutions provider must align on a set of shared goals and objectives, including:
ACOs depend on data to identify high-risk patients, track their health status, and coordinate care across providers and settings. Comprehensive and high-quality data enables ACOs to understand the health needs of their patients, identify gaps in care, and implement tailored interventions to improve outcomes and reduce associated medical costs.
Accurate data can equip ACOs to stratify patients based on risk levels and ascertain future health outcomes, such as emergency department (ED) visits, inpatient utilization, readmission, discharge records, and upcoming appointments (and whether or not they miss them), enabling providers to intervene if necessary.
Take annual wellness visits (AWV) as an example. Typically, patients who engage with providers every year to evaluate the patient's health status and risk factors fare better overall. In addition, healthcare providers find that AWV adopters are more likely to engage in preventative care in areas like breast and colorectal cancer screening, diabetes HbA1C control, fall risk assessments, hypertension screening, and immunizations for influenza and pneumonia.
More compliant healthcare consumers also require less care coordination, use fewer services, such as hospital admissions and emergency department visits, and have lowered risk-adjusted per member per month (PMPM) risk scores.
While each member of an ACO can uniquely benefit from in-depth analytics, high-value healthcare data analytics gives all stakeholders insight into these trends, providing a feedback loop that maintains accountability in cost-cutting measures associated with value-based care.
Using advanced analytics to identify patients based on their utilization, chronic conditions, demographics, and gaps in care can assist providers in monitoring events and identifying areas for ongoing improvement at the point of care.
With a committed team and advanced analytics platform, it is feasible to extend the implementation of crucial programs that assist network partners, incorporate claims and clinical data sets, and expand into other departments or quality goals.
High-value analytics platforms have, anecdotally, enabled ACOs and value-based care providers to achieve systematic results in various domains, including:
In conclusion, modernizing data and analytic systems is no longer a luxury but a necessity for ACO partners. With the ever-increasing data available, the demands of patient care coordination, and the need to control costs, making informed decisions based on actionable insights becomes imperative. Therefore, organizations must execute methodically and consider specific needs and objectives rather than indiscriminately adopt new tools.
For mission-oriented ACOs, there are vital considerations that must remain at the forefront during the planning and adoption phase:
Advanced analytics is critical to population health management and equitable care delivery as it addresses multiple areas for improvement. Indeed, organization-wide implementation of advanced data and analytics technologies can bolster patient-provider encounters, advance therapeutic results, generate operational efficiencies, and restore long-term fiscal stability.
Clients have achieved $1.5 billion in measurable improvements with the help of Health Catalyst's data and analytics technology and professional services. To discover how to implement a robust data and analytics platform to enhance clinical and financial objectives, go to HealthCatalyst.com.
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