Monitoring, Measuring and Managing Accountable Care Organizations (ACOs)

The Uncoordinated State of ACO Care Coordination

ACO care coordination in health care requires ensuring that the right information reaches the appropriate party at the optimal time to make patient care better, more efficient, and less costly. This coordination needs to occur among the various parties involved in a patient’s care. However, major problems in care coordination still exist, including:

• Electronic systems that can’t talk to each other
• Poor communication about patients among health care providers
• Lack of access to patient information
• Redundant data capture and communication efforts
• Lost or forgotten orders and missing results
• Inefficient scheduling
• Complicated and time-consuming point-of-service collections
• Mismatched claims for same-patient treatments from ordering provider and facility
• Improper coding resulting in denials and resubmissions

Making care coordination work is critical for keeping health care costs down, improving the quality of patient care, and ensuring the long-term viability of health systems. The Patriot Labs ACO Performance Management Working Group is focused on outlining solutions that can help ACOs grow and strengthen their physician networks, reduce costs, boost revenue, and improve the patient experience overall.

“A cost-effective and workable system for optimal care coordination that takes into account complications of establishing interoperability among ACO partner information systems, clinical information exchange, patient communications, and CMS compliant performance reporting has not been fully realized, and in many cases is nonexistent.” – Ron Garnett, Executive Director of Patriot Labs

Monitoring, Measuring and Managing MSSP ACO Performance

The Patriot Labs ACO Performance Management Working Group is being organized to define, develop and deliver an ACO integrated performance management platform that embeds business rules and algorithms of the Medicare Shared Savings Program (MSSP) Accountable Care Organization into a cloud-based performance monitoring, measurement and management application. The group which plans to hold their first virtual summit on January 15, 2014, will initially develop a performance management solution that supports the following capabilities:

• ACO benchmarks and budget based on historical cost baseline, trend estimates and risk adjustments
• Performance monitoring of key measures and metrics related to cost, utilization and quality
• Predictive modeling to determine the proper mix of inputs to maximize payment incentives
• Dynamic dashboards and visualizations to perform trade-off analysis and scenario planning

Information ACOs Need to Reach Peak Performance

Recognizing the critical information challenges that many ACOs face, the Patriot Labs ACO Performance Management Working Group is focused on providing a MSSP ACO compliant platform that delivers immediate visibility into all critical aspects of ACO performance management. It will provide:

• Interactivity – Easily access data from multiple sources
• Accessibility – Cloud-based access means data is available anywhere you have a broadband connection
• Security – Role-based security that ensures users have appropriate data access
• Speed – Lightning-fast time-to-insight queries and exports
• Simplicity – Point-and-click interfaces that are easy to master
• Precision – Ability to focus in on desired performance data, down to the line-item level
• Integration – Ability to share findings with full export capability
• Relevance – Tailored to produce actionable information across the entire revenue cycle

Making the Transition to ACO Business Intelligence

More and more ACOs are realizing that business intelligence systems are needed in an increasingly complex data environment. What’s needed is an ACO performance monitoring, measurement and management solution that streamlines the process of digesting and synthesizing complex information, and that brings actionable data to the right individuals within the organization, when they need it, to improve performance.

“The platform developed by the working group will allow ACOs to analyze all data through specially designed views, identifying and examining critical trends and patterns. It will also go a step further by presenting data at a higher, more summarized level. With monthly reports relevant to provider and business performance, ACOs will receive timely results and performance trends to ensure ACO-wide alignment with key goals.” – Ron Garnett, Executive Director, Patriot Labs

The Patriot Labs and Prime Dimensions Difference

Patriot Labs and Prime Dimensions are focused on making ACO work as they should. To us, coordinated care and clinical integration is a continuous process of alignment across the care continuum that supports the triple aim of health care – improving quality of care, reducing or controlling the cost of care, and improving access to care and the overall patient experience.

A solution platform developed specifically for ACOs, by ACOs. As sponsor of the Patriot Labs ACO Performance Management Working Group, we are committed to delivering a clinical integration and payment reform model focuses on delivering the right information to the right person at the right time by helping to align incentives, build relationships, and create efficient behaviors with the use of appropriate technology. As a multidisciplinary collaborative, we aim to deliver results by creating efficient processes, services and interfaces to capture data from all delivery systems, because we know that patient information – clinical, financial and demographic – is a cornerstone of improving healthcare outcomes. We also understand that the time of ACO partners is valuable – so our managed data services supply business intelligence and performance information that enables ACO partners to make better operating decisions. Moreover, by joining the right information along with directives within the ACO workflow, we empower providers to make high-value, high-quality clinical decisions at the point of care.

About Patriot Labs

Patriot Labs provides information management, technology solutions and advisory services to public institutions and private companies worldwide. Our clients are senior executives and management teams at large and mid-sized organizations, government agencies, and non-profit organizations. From a global collaboration network, Patriot Labs leads interdisciplinary working groups through the process of analyzing major challenges, developing innovative solutions, and disseminating next practices. For more information, please contact Ron Garnett for additional details (rkgarnett@Patriot Labs.com / 202.643.4766).

About Prime Dimensions, LLC

Prime Dimensions, LLC provides professional consulting services in data management, business intelligenceand advanced analytics, with focus on operational aspects and emphasis on Big Data strategy and technology. We assist organizations in transforming data into actionable insights to improve performance, make informed decisions and achieve measurable results. By utilizing a lean-startup approach and agile delivery model, we create inter-disciplinary, integrated teams of specialists to guide, build and deploy solutions that provide transformational impacts through advanced analytics and data visualizations. We partner closely with clients to ensure cost-effective implementations. Our team of highly skilled professionals assists organizations in establishing a Big Data strategy for extracting, consuming and sharing information from massive amounts of disparate data across multiple internal and external sources. For more information, please contact us at info(at)primedimensions(dot)com or 703-861-9897.