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Imaging is a large margin of any hospital organization, and hos-


pitals are spending lots of money on their imaging solutions. T ough not all have a consolidation piece, especially when it comes to storage. T e use of storage is growing dramatically and will only become more expensive over time for this very reason. Managing these costs is key. From an administrative cost perspective, hospitals pay on average $80 per call to verify insurance for a procedure (staff costs, physician time, etc.). Recent data shows our industry makes this call 122 million times per year, roughly a third of the images taken in a given year. As an ACO, there needs to be a way to collaborate and reduce these


costs across an organization. T ere will be a laser focus on images and fi nding ways to access and share images across networks, ultimately looking to reduce that $80 [call] to $10 per image.


Joe Damore, Vice President of Engagement and Delivery, Premier Inc.


In healthcare, we lack a way to zero in on data points that signify something meaningful. In addition, there is not a proven system that integrates claims data


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and clinical data. Many companies are working on developing this Holy Grail. And there are plenty of siloed approaches in healthcare to integrate data – EMRs are one. Providers (ACOs) are also building dashboards based on Triple Aim metrics in areas such as utilization, quality, per capita costs and patient satisfac- tion and engagement. T e challenge is integrating these disparate electronic medical


record systems (clinical data). EMRs alone can’t help providers understand what’s happening across the entire continuum of care, parse all the inputs or point out predictive trends. Providers are spending a lot of time focusing on managing these data sets and separate technology infrastructures and not enough time using meaningful information that can help them understand what interventions need be made to improve patient care and further predict variances to improve the overall health of their populations. Reform pushes providers toward population health manage- o


ment, yet few providers have the IT capabilities to make it reality.


Barry P. Chaiken, M.D., MPH, Chief Medical Information Offi cer, Infor


Unlike integrated delivery networks, ACOs in their fullest sense are truly an integrated care delivery entity that com- bines both care delivery, at every level of care, with fi nancial risk. T erefore, ACOs must carefully manage care and costs across the entire spectrum of care: inpatient, ambulatory, and subacute care (e.g., rehabilitation, skilled nursing, etc.). First, an ACO must establish relationships across a broad fi eld of care providers while implementing management tools to track quality of care, clinical outcomes and cost of care. If the ACO is at fi nancial risk for the care provided – value-based/capitated reimbursement – the ACO must be sure that the affi liate organizations that provide care to the covered population do so in a manner that matches the clinical and fi nancial goals of the ACO. ACOs must establish reliable links to the fi nancial and clinical systems of each of their partners. T ese interfaces provide the raw data necessary to track actual costs and clinical results. T e ACO must understand the true cost of providing various levels of care and link that back to the clinical outcomes. T is task of linking systems and monitoring outcomes is not easy. Nevertheless, ACOs must focus on building these reliable links and then applying busi- ness intelligence techniques to monitor results on a frequent basis.


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What are some of the steps they should take to overcome these challenges?


David Janotha, Industry Vice President, Healthcare, Axiom EPM


ACO payments will be based on cost and quality, so understanding the drivers of those components will be important to the success of the ACO. An eff ective performance management system that allows seamless integration of data from various sources will be necessary to have access to the critical information needed. T e organization will need to be able to assess the activities contributed by the members and analyze variances across providers. It is only with this information that opportunities to improve can be identifi ed, addressed and monitored.


T e key will be to understand the variable and direct cost drivers for each of the members and the impact of practice patterns on the total variable cost. T at information will facilitate physician practice changes by quantifying their decisions and generating monetary impact values. It will also be important to be able to combine quality data so that decisions are not made on cost alone that could subsequently lower the quality of care. T e data must be integrated across providers but also consolidated


by encounters and episodes of care. It will be important to analyze inpatient stays along with the related outpatient activity after discharge and any related re-admissions. T e system utilized to integrate the cost data must also therefore support providing service line views that are inclusive of care provided across settings and events (i.e., inpatient stays and outpatient visits).


Jim Lacy, CFO and General Counsel, ZirMed


One of the fi rst manifestations of ACO complexity for organizations is fi guring out what patients, providers and care are going to be paid for as part of the ACO/bundled payment model. ACOs need to put in place "early warning" systems that will fl ag clinical encounters that may become part of a bundled payment as they progress. T is issue is a great example of how ACOs need operational and


fi nancial procedures that are normalized across all internal and external participants. ACOs are going to need to align with partners that can handle the complexities of bundling/unbundling payments beyond the scope of core fi nancial systems. Clearinghouses, banks and a wide range of services and technology partners can play a role in this support.


Joe Damore, Vice President of Engagement and Delivery, Premier Inc.


Providers must invest in technology that can integrate, scale and evolve information across their entire system, instead of using disparate vendors and sources of data. T ey need technology that can interpret their information quickly and effi ciently to provide a more complete picture of patient care and a better understanding of outcomes and total cost, including care delivered outside the hospital.


Investing in one IT platform/solution that has total cost of care capabilities, which providers can use to integrate trusted data across their health system, is one step. Technology like this can integrate population- and claims-based data, as well as technologies from all types of vendors. T e new population health/ACO fi nancial systems will require a much deeper understanding of the "production costs" of care across many diff erent care settings (ambulatory, acute, post-acute)


HEALTH MANAGEMENT TECHNOLOGY March 2014 7


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