● Accountable Care Organizations
Setting the stage for ACO performance
T e key is streamlining clinical, fi nancial and operational information. By Don Pettin
risks to providers. To thrive as an ACO, healthcare organizations must un- derstand not only their true costs of care delivery, but the correlation between therapies, costs and outcomes. T e ability to turn these silos of disparate data into actionable insight is no longer nice to have – it’s a must have. Enterprise data warehouses and analytical applications
are the keys to unlocking this insight. Building a business intelligence environment from the ground up, however, has historically caused trepidation even among the most seasoned IT organizations, requiring huge investments of time and money. Times are changing. ACOs, which as of July 2012 were serving 2.4 million pa- tients in 40 states and the District of Columbia, are expected to gain momentum as healthcare reform rolls out in earnest. T e success of the ACO model depends on the ability to incentivize healthcare organizations and providers to form links and facilitate coordination of care delivery to eliminate redundant and unnecessary services. T ere are risks and op- portunities associated with this model. If costs fall below a set budget, ACOs, which today largely serve Medicare patients, share in the profi ts. If costs exceed the budget, they bear some of the losses. T e stakes are high, and ACOs are looking to their data infrastructures to help them strike the right balance.
Getting a complete picture To navigate risk and fulfi ll their potential for delivering high-quality care and outcomes at a lower cost, ACOs require a new level of business and clinical intelligence. T ey must be able to defi nitively answer these questions: • Who are our patients, and how is their health as a popula- tion (including chronic and acute problems)?
• What services do we deliver to them? • What is the true cost of these services and procedures?
14 January 2013
ccountable care organizations (ACOs) stand to transform the delivery of healthcare as we know it by arresting spiraling costs while improving outcomes. T e model, however, is not without
Don Pettin is senior director, healthcare product strategy, Oracle Health Sciences. For more on Oracle Health Sciences: www. rsleads.com/301ht-206
• Is there an alternate path that can improve outcomes and reduce costs?
• Can we identify gaps in care and the impact addressing them will have?
T e questions appear deceptively simple. Most healthcare organizations, however, cannot answer them precisely for them- selves, let alone when coming together with other providers as part of a larger group. To understand true costs and outcomes, ACOs must bring together several critical pieces of internal and external data, including: • Patient information, such as demographics and family history;
• Clinical data, such as lab and test results, medical history, medications, procedures and other information typically found in electronic medical records (EMRs) and electronic health records (EHRs);
• Financial information about the costs, direct and indirect, of services provided;
• Outcomes, including improvement in vitals, quantitative disease measurements (such as HbA1c), reduced hospital- izations, etc.; and
• Claims or health information exchange (HIE) information, as patients often go outside of the ACO for care. Organiza- tions have historically faced roadblocks in integrating these disparate internal and external data sources. T ose that have made progress on the integration front often continue to struggle with the ability to analyze the data in a timely manner to yield actionable insight.
New times call for new approaches How can healthcare organizations build the data and analytical foundation that they require in the age of ACOs? T e good news is that many already have at least some of the building blocks in place. Core to any eff ort is data governance. Particular aspects of data governance can help with topics such as terminology mediation and standardization, along with master data management. In addition, providers no longer need to develop these solutions alone as there is a growing set
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