There are many ways for accountable care organizations to manage the health of the populations they are responsible for, but health analytics has to be at the center of ACOs' efforts, according to presenters at a webinar.
Most health care workers assume that ACOs are synonymous with health information exchange (HIE). But this doesn't necessarily need to be the case, said John Houghton, M.D., chief medical information officer at Covisint, in his presentation for ACOs in the Real World, hosted by the eHealth Initiative.
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Houghton described what he called "captive" and "collaborative" ACOs. The former type involves large providers, such as hospitals, in which all the activities for managing the health of patients center on interacting with a core health information management system, such as an Epic or Cerner electronic health record (EHR) system. These providers might not need to participate in an external HIE.
Collaborative ACOs, on the other hand, are made up of a collection of smaller providers that have weaker affiliations and often use different IT systems. These organizations are much more reliant on HIE.
Regardless of the form taken by a particular ACO, health analytics needs to be the primary focus, the presenters said. This is the only way providers can identify patients who are likely to need the most care, take preventive steps to keep these individuals well and measure the organization's progress against benchmark data.
"We're really talking about getting the key data, the key information, the key needs of the patient to the right point in the workflow when it can be acted upon," Houghton said.
Many health care organizations currently do some form of health analytics, but it primarily focuses on retrospectively studying administrative data. John Stanley, a principal at the Impact Advisors LLC consulting firm, said this kind of analytics is important, but for ACOs to truly be effective in managing the health of populations, they need to focus on prospective analytics as well.
We're seeing a potential tidal wave here in purchasing and investment. More and more organizations are beginning to ask themselves 'how do I get the data that's usable and clean, and then how do I turn it into my care management model?'
principal, Impact Advisors
When organizations use health analytics for more predictive functions, they are able to develop personalized care recommendations, run effective clinical decision-support systems, eliminate duplicative testing and reach out to patients who are the most likely to require follow-up care, Stanley said. Given current trends, the health care industry is likely to start rapidly adopting predictive analytics technologies.
"We're seeing a potential tidal wave here in purchasing and investment," Stanley said. "More and more, organizations are beginning to ask themselves 'How do I manage this? How do I get the data? How do I get the data that's usable and clean, and then how do I turn it into my care management model?'"
Arthur Wilmes, principal at consulting firm Milliman Inc., said that effective health analytics can help ACOs answer some of the questions that are central to their operational and financial success. Most importantly, he said, analytics can help organizations measure the cost-effectiveness of their disease management efforts.
In general, ACOs make money by minimizing the health care expenditures of their patients and keeping a share of the savings for themselves. For patients with chronic diseases, this approach often means being assigned to care management teams that assist them in controlling their symptoms. This strategy generally leads to lower chronic-disease management costs, but some patients may not benefit, Wilmes said. There is a point for every ACO where bringing on more care management professionals and putting more patients into this form of care will not be cost-effective or contribute to improved patient health.
Analytics can help ACOs understand where this point is. More than just identifying patients who are likely to need the most care, health analytics systems enable organizations to understand how to treat these patients effectively. "Simply knowing someone is at risk fails to satisfy the real need -- which is 'what is the level of risk, what factors have the most impact on the level of risk, what efforts can I deliver to reduce the level of risk and what is the net return should I choose to manage that risk?'" Wilmes said.
Of course, this doesn't mean that there is no role for HIE in ACOs. All three presenters said information exchange can facilitate the dissemination of data and care management plans developed through analytic programs. This is important whether an organization operates as a collaborative ACO (in which many different medical offices are responsible for a patient's care) or a captive ACO (in which many different departments are involved in caring for patients).
Health analytics and HIE, along with patient engagement efforts, are among the most important strategies ACOs can employ to improve the health of their patients and their own financial stability, the presenters said. While most organizations have started to consider the role of patient engagement and HIEs in their operations -- thanks in part to provisions of the meaningful use rules -- some may be further behind when it comes to deploying analytics.