Many providers hesitate to embark on the transformation into accountable care organizations (ACOs) for two major reasons: anxiety about downside risk-based payments models and the challenge of balancing fiscal performance with the mission of delivering high-quality care.
To successfully transition into an ACO, providers must constantly refine workflows, processes, and performance indicators. To this end, analytics are the ticket to remaining on the cutting edge without teetering too far into the unknown.
When Success Depends on Data
The first step in ensuring ACO success is identifying ways to improve performance and push insights into clinical workflows. Then, once an initiative is in progress, ACOs need to monitor performance to ensure they are achieving the desired return on investment. With that information to guide strategy and negotiations, ACOs will be able to handle more risk-based contracts and greater contract complexity.
After they have plucked the low-hanging fruit in value-based care (VBC)—like reducing skilled nursing facility (SNF) length of stay and improving post discharge follow up— analytics can help ACOs prosper in increasingly complex risk-based payment models.
Success depends on access to the right data and making that data work. At a minimum, ACOs need claims data combined with clinical information from electronic health records (EHRs), then supplemented by other sources.
Ultimately, metrics and data-driven insights can power better ACO performance by:
- Informing when and how to take on upside and downside risk and supporting more effective negotiations for VBC contracts
- Identifying the best opportunities for population health initiatives to make the most of investments
- Determining the impact programs and infrastructure investments have on clinical and financial outcomes
- Providing reports that support well-aligned performance incentives
One ACO’s Story: Better Outcomes, Lower Costs
An ACO with locations across several states prioritized use cases where data should drive workflows. For example, active management of patient attribution is critical for success in accountable care. That information includes who patients are, where they are, how sick they are, and what services they need to achieve optimal outcomes.
This ACO derives value from data in three essential ways:
Workflows: Data informs day-to-day clinical workflows, stratifying patients and maximizing the value of each interaction.
Provider incentives: Data gives providers real-time visibility into their performance and opportunities to improve care in the short term. Data also informs incentive programs for physicians and care team members. Aligning the incentives of providers with the ACOs can help drive a higher level of performance improvement.
ROI analysis: Analytics enable assessment of population health program impacts and inform strategic decisions, including growth and program development and clinical workflows.
Value creation as an ACO requires careful thinking to balance drivers in people, processes, and technology. For example, improving patient outcomes creates success for ACOs in VBC contracts because cost savings often follow.
In an initiative to improve patient outcomes, the multi-state ACO assessed SNFs to determine whether they were able to get patients home safely and reduce length of stay and readmission rates, ultimately producing cost savings. With data analysis to guide daily workflows and discharge planning efforts, the ACO determined that its efforts did reduce overall SNF days per thousand, the major cost driver in a Medicare ACO.
The ACO also analyzed annual wellness visit (AWV) impacts. The analysis looked specifically at whether AWVs were improving quality outcomes, capturing disease burden, and encouraging loyalty. An earlier AWV strategy boosted visits to over 75 percent of the eligible population. The healthcare system wanted to determine if AWVs produced a real impact on the population.
The results demonstrated improvements in patients’ lives and increased resources for the ACO. Quantifiable improvements in risk and quality gap closure as well as patient loyalty where identified.
Separately, a key to success in VBC is managing and motivating a mixed group of employed and independent providers to engage in programs and drive outcomes. Providing appropriate incentives for performance certainly helps.
Accordingly, the ACO set a goal to reward physicians who proactively manage their patient panels and make the greatest positive impact on VBC contracts and patient outcomes. The organization developed sophisticated metrics to appropriately identify and incentivize physicians based on quality scores, disease burden accuracy, and utilization metrics.
Specifically, the ACO assessed each primary care provider’s panel and determined their risk-adjusted admissions per 1,000 and impact on the group’s overall quality performance. Based on those two factors, the ACO was able to give primary care providers appropriate incentives along with actionable data to continually improve.
Analytics inform when and how to take on upside and downside risk and provide data critical for negotiations to develop win-win arrangements. Identifying the best opportunities to create new population health initiatives helps deliver the greatest return on investments. A sustainable ecosystem—where finances and delivery of care are both at optimal performance—is built on incremental changes. With analytics in place, one success begets another, enabling further investments in VBC and determination of program impacts on clinical and financial outcomes.
Jacob Hochberg is the executive director of customer insights at Arcadia, a population health management and health intelligence platform.