Accountable Care Lives Or Dies On Performance Data

Reid Hoffman, the co-founder of Linkedin, made his fortune by realizing the Internet's future was all about social media. Now he sees "another tectonic shift on the horizon," according to the New York Times. This one is driven by data.

That prediction is spot on, and there's no better place to witness the tectonic shift than in healthcare. As providers struggle to meet requirements for federal Meaningful Use (MU) dollars and get ready to qualify as accountable care organizations (ACOs), data has taken center stage.

The Centers for Medicare and Medicaid Services (CMS)' list of MU core requirements includes the need to maintain an active medication list, getting more than 40% of your practitioners to use e-prescribing, and keeping track of patients' smoking status. Similarly, CMS's recently published final rules on ACOs require healthcare organizations to meet 33 quality measures. They have to provide pneumococcal vaccinations, for instance.

In order to meet CMS standards and share in a variety of financial rewards, healthcare providers will have to collect, analyze, and report their success at meeting these quality measures. But before you can figure out how to best do this, you first have to perform; i.e., your clinicians have to offer patients the kind of high-quality care that CMS expects.

[For more background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch.]

One way the IT team can help with that goal is to install evidence-based order sets and alerts into the EHR system to prompt providers to meet the required quality measures.

Dr. Scott Weingarten, CEO of Zynx Health, a vendor offering clinical-decision support tools, provided a good example in a recent phone interview. One of the quality measures that CMS will be looking at requires ACO clinicians to take appropriate steps to prevent patients with certain disorders from being readmitted to the hospital within 30 days of discharge.

For example, a very high proportion of patients with congestive heart failure is readmitted, but the risk of readmission can be mitigated if the patients are given aldosterone antagonists upon discharge. So ACOs will be held accountable for readmissions if their doctors fail to prescribe these meds, Weingarten said. Having the appropriate reminders and order sets in the CPOE system will help keep clinicians on track.

Seth Henry, founder and CEO of Arcadia Solutions, an IT consulting firm, offered additional tips on how to help providers meet CMS-mandated quality measures during a recent InformationWeek Healthcare webcast.

Consider the Stage 1 MU requirement that providers have a record of the smoking status of 50% of patients 13 years of age and older. One of the first steps to meet that goal is to give each clinician a clear view of his or her performance, Henry said.

That doesn't necessarily mean you have to build a huge data warehouse to collect performance data before you can approach clinicians with their stats. Most EHRs already contain a lot of the data needed to meet many MU and ACO standards, Henry said, and you can get to it with relative ease, using tools such as Excel, Access, and Crystal Reports.

If you go that route, don't make the mistake of collecting only aggregate data; that only tells you how the group as a whole is doing. To meet the goals outlined by CMS, your data crunching needs to generate individual scores, according to Henry.

So in the case of smoking status, it's not enough to know that 30% of your clinicians aren't collecting this information. You need to know how well Drs. Smith, Jones, and Black each are faring. And that data must be collected routinely and over an extended period so you can generate trajectories that show how each doctor is progressing.

That kind of individual accountability can pay real dividends. One of Arcadia Solutions' clients found that providing individual reports to clinicians resulted in a 60% jump in compliance over six weeks--without any additional interventions.

Hoffman was right, data is the next hot spot in IT. Get your clinicians to buy into this future before you're left behind.