POSTED : April 21, 2015
BY : ProKarma

Accountable Care Organizations (ACOs) including participating Providers and Payers wrestle with growing, increasingly risk diverse patient populations, and higher patient expectations for health outcomes, provider performance, and decreasing share of the wallet while simultaneously struggling to do more with less in the face of dwindling resources and shrinking budgets. Adding to this complex­ity are state and federal mandates (such as CMS PQRS, Joint Commission Core Measures, Health Reform mandated Quality Reporting like Meaningful Use and ACO measures) besides development of appropriate Pay-for-Performance reimbursement models which call for improvements in quality of care rendered, operational effectiveness and fiscal responsibil­ity, and reduction of health disparities. Unfortunately, many ACOs lack the ability to measure their overall effectiveness of health care practices or strategically allocate resources to address current and emerging needs.

In addition, access to federally funded programs, grants and/or private funding for healthcare delivery is often dependent on timely, reliable data and reports. But while every ACO has scores of data – on staff, patient encounters, claims, services rendered, financial performance, clinical findings/observations, etc. – so much time is spent trying to get the information that there’s little time left for things like staff development, quality and performance improvement and practices. As such, trends go undetected, funding or revenue is lost and issues don’t get addressed as quickly as they should be.

Challenges abound as the ACO attempts to gather the information that will allow it to cut costs, yet deliver the highest quality of care to its constituents.  Specifically, these challenges include:

  • Lack of data integration. There’s an abundance of valuable data in disparate clinical (EMR, etc) and business information systems (PMS, HIS, Claims, etc), but without centralized data, reporting and associated methodologies, there’s no way to access or make sense of it all.
  • Shortage of useful information. Limited staff resources don’t have the time, technologies or skill sets needed to turn volumes of data into information that could be used for evidence-based decision making.
  • Resource and funding constraints. Budget cuts have meant tight funding and insufficient staff available for HIT initiatives to comply with health reform objectives.
  • Reporting and transparency requirements. State and federal initiatives, Payer Pay-for-Performance initiatives and Private/Grant funding sources have magnified the huge burden of performance reporting and analysis, along with demands for transparency.

The vast amounts of data captured by healthcare organizations are often stored in multiple systems that cannot be easily accessed. With limited resources and budgets for clinical decision support and performance management technology, ACO staff (clinicians, administrators and executives) find themselves unable to quickly get the clinical, operational and financial performance information they need in order to make strategic decisions that can benefit the ACO, its network of healthcare organizations and their patients/members.

The ideal analytics solution partner allows the ACO to resolve key issues, as follow:

Easy-to-use interface

What if you had immediate Web access to key data and reports – on process, outcomes, financials, etc.?

Macro to micro view

What if you could view ACO informa­tion as a whole, then isolate the view to a targeted location, department, provider and QPI, and drill down further to the individual patient?

Sophisticated analysis

What if ACO leaders could not only access basic reporting, but also view the trends and patterns that would enable them to make proactive decisions?

Customized benchmarks

What if you could compare your provider or care team performance against organization-wide performance or against customized benchmarks so you could determine, at any time, whether or not a business or clinical intervention were needed?

Low Cost of Ownership

What if someone else took over consoli­dating, analyzing and reporting on your data – leaving you the time to focus on improving the quality and performance in your ACO?

Congratulations on being approved as an ACO.  Armed with the right analytics solution; you will do many great things!