It isn’t always clear which road to take when tackling ACO reporting. Senior healthcare BI consultant, Ali Rizwan helps give a little more direction and a few concrete tips to solve the problem.
As part of the push for population health ACOs are growing yearly and already number in the hundreds. There are currently around 500 ACOs nationwide. This number is expected to continue to increase in the next few years. With adoption occurring at such a rapid pace, it is important not to miss some of the real keys to improving patient care and increasing patient engagement. A recent meeting of Pioneer ACO executives (27 of the original 32 are still in the program) reminded the new entrants that the key to successful patient engagement is reliant on the data produced by the ACO. The investment in an ACO reporting solution is what enables the ACO to determine which patients to engage. It also allows all the patients to be brought into the fold in order to meet the ACO 33 measures defined by the MSSP initiative. As ACOs enter the MSSP program, reporting will be crucial in differential approaches to patient population management and risk level assignment to the patients.
A Typical Scenario
While the need for quality data is almost universally understood, the path to get there isn’t as clear-cut. Providers and administrators often struggle with the additional workload of manually managing data. Let’s follow a typical physician and a health care administrator in their daily routines to help illustrate the challenges each face with ACO adoption and reporting:
Meet Dr. Brown
Dr. Brown is tasked with providing care to his daily caseload while also having to identify the patients who are non-compliant on the ACO 33 measures. He has an EMR system but he doesn’t have time to find out which patients haven’t been engaged to get the quality or preventative screenings required. He is torn between the task of delivering high quality care—which is his passion, while also scouring the population health data—which he doesn’t have time or adequate training for. The challenge above is a common theme across ACOs. Providers aren’t always equipped with the tools they need to give patients the attention they deserve while also hunting down non-compliance or gaps in care through their EMRs.
Meet ACO Administrator Nancy
Nancy is managing the contract of the ACO and profiling the reports that show which patient engagement opportunities exist. Nancy and her team are consumed with managing complex contracts and the pay of the sharing structure while also alerting doctors of patients who have gaps in their care. Her team is getting the ACO rate reports to the doctors, but due to the lag in the data available they have no time left to focus on improving patient care and engagement with the doctors. The IT team is backlogged and can only provide extracts which Nancy’s team manually massages to generate patient lists and rates to doctors for their non-compliance or gaps in care. This time consuming process is taking away her staff’s ability to properly analyze the data. The final result is that the reports are delivered late and lack real insight into patient details.
So what’s the solution?
The solution to both these problems is found in proper analysis on the ACO reporting methodology and assessment of the system through three key areas:
- Data Integration Layer – This is the most difficult step (even more than the presentation layer phase), which identifies all the sources.
- Presentation Layer – This step outlines the use cases of the data and how the providers and administrative staff of the ACO will get access to information vs. just the data.
- Operationalize Data Usage – This step discusses engaging providers to ensure data is used in a way that drives patient engagement. Moreover, what is required for success with this initiative.
So far we’ve identified some common data issues that ACOs are currently dealing with. We have also briefly outlined three keys to resolving those problems. In part two of this series, I will walk through each of these areas in much more detail; providing some additional considerations that are important in determining the approach for your system.