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How 3 ACOs Use Technology To Survive

Nine accountable care organizations are dropping out of a program touted as a key cost-saving element of Obamacare. Here's how three providers are using technology to stick it out.


Once a provider collects and aggregates patient information, it needs to analyze the data in order to identify gaps in patient care, Halamka said. Many ACOs have created data warehouses for clinical information, and they're using those to analyze and assess patient wellness.

Part of the assessment includes patient rosters used for population health management, which provides primary care providers, population managers and care managers with a holistic look at all of a system's chronic-care patients, Lopez said. These rosters can identify gaps in care by spotting people with certain conditions who are in need of preventative care measures or by identifying those whose test results are abnormal.

For example, a doctor would be notified if a patient with asthma didn't receive a flu shot, and the care manager would take action to get that patient vaccinated, instead of treating the patient after he or she was already infected.

There is also a high-risk Medicare roster that identifies patients with a high risk of being readmitted. Doctors can then take steps to prevent re-admittance.

Quality metrics are also taken from the data, Lopez said. These metrics are part of the calculation of how one gets paid for the care of patients.

A major challenge in data analysis has been standardizing medical terminology, Halamka said. One doctor might diagnose a patient with hypertension, another doctor might call it high blood pressure and another might call it elevated blood pressure. The solution is mapping. BIDC combatted this problem with Massachusetts eHealth Collaborative, a nonprofit company that takes data from multiple systems and maps common terms to enter them into the database in a standard form.


Once the information and analytics pieces are in place, providers still must take the right actions to deliver quality care, Halamka said. Often that requires changes to the processes within the management of a practice. BIDMC, for example, places "pod leaders" within each practice who are responsible for disseminating data on performance to doctors and holding them accountable for quality and costs.

"You must have a foundation of IT in order to manage risk," Halamka said. "It is impossible to use standard tools that were great in a fee-for-serving world in an accountable care world that requires continuous management of wellness."

Key challenges looking forward will be managing risk and keeping the ACO model viable, especially considering the mixed reviews of Tuesday's CMS report. CMS reported that all the ACOs proved adept at improving care quality, but many couldn't deliver the sought-after cost savings.

Better IT systems for managing and analyzing patient data will be one element of lowering costs. For example, all 32 pioneer ACOs met their quality reporting requirements, but "we also know that simply reporting these measures took too much time and resources, and that Pioneers and MSSP ACOs need better solutions for handling the administrative side of these contracts," said The Advisory Board's Tom Cassels, in a Q&A on the consultancy's site.

Another survival element for ACOs goes back to those patient engagement systems, and whether ACOs provide an experience that keeps customers happy.

"The interesting thing about the current state of ACOs is that we call them accountable care, but the only person that is accountable is the provider," Spooner said. "The patient has the option to go to any provider they want, yet the provider is accountable for the care and the cost. We need to do our best to make sure the patients come back."

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User Rank: Apprentice
8/1/2013 | 3:08:48 AM
re: How 3 ACOs Use Technology To Survive
I think that you hit on every point needed for ACOs to be successful here. It isnG«÷t an easy undertaking and encompasses much more than most organizations think. From successful implementation of EHRs, to patient involvement, and data analytics, successful ACOs need to be able to adapt and use technology to their benefits. As you say, the provider is the one that is accountable here, so they have to use all methods available to keep the patients happy and healthy.

Jay Simmons
Information Week Contributor
User Rank: Apprentice
7/25/2013 | 10:32:41 PM
re: How 3 ACOs Use Technology To Survive
I just read, with interest, your article in Information Week about how three ACO's are using technology to survive. It is a good article, however I want to make a few comments. I am re-entering the field of medicine after a 12-year absence from clinical practice. Back in 2001, hospitals were just beginning to talk about EMR. I had a little experience with the VA system in Northern California. I am hopeful that data can be used in ways to increase my productivity as well as promote conditions that generally enhance patient safety and general well-being.

During the past 5 years I went back to graduate school and earned an MBA in General Business Administration. I learned there that in general, IT projects have failed to deliver expected gains in productivity approximately 65% of the time, across all industries. Why should we think that healthcare industry would be any different?

I have talked to some of my former colleagues who are now working with EMR, usually because it has been imposed upon them by the hospital system with which they are under. They tell me that productivity has gone down. Before EMR they could easily see 25 patients a day in our specialty. Now they can barely see 16 patients a day. This is a considerable drop, and they are into EMR two years or longer now. Isn't there data available on this drop? I would really like to know what kinds of date the hospital systems are collecting regarding adoption and how they are using this data to improve adoption and productivity. If productivity suffers permanently, how can we say that EMR is good for overall healthcare, given the current doctor shortage? In another way of speaking, isn't being seen by a doctor when you need one more important to overall healthcare than EMR adoption?

Another thing that concerns me is the data being gathered and how it is looked at. Sure, it's easy to design EMR with alerts for needed vaccinations and medication renewals, but I thought there was a movement within healthcare IT to design program functionality around the needs of doctors and other team members delivering care, instead of programming for needs that are defined by IT professionals with no healthcare experience or training.

For example, a doctor doesn't need an EMR program to alert him to the fact that a 94 year-old male with chronic renal failure and hypertension needs to be on the High Risk Medicare Roster. Furthermore, unless someone is constantly performing home visits and reminding the patient weekly to cut down on salt and take his medication, and watch his diet, he will invariably require hospitalization again when his condition deteriorates. This is the dilemma of ACO's. There is very little they can do to keep some patients "healthy" as defined by lessening their need of additional outpatient or inpatient services. The effort needs to be put into prevention at a much earlier stage in people's lives, before they ever get to the ACO. The way I see it, ACO's are merely gambling with numbers of various patient groups, and the more sick their demographic is, the less likely they are going to save the system any money, and less likely to remain profitable themselves. The only way they can remain viable is to not admit patients to their organization with high utilization needs, so risk reduction for the ACO becomes necessarily focused upon patient selection. In science, we would call this "selection bias" if we were doing a scientific study.

What are we going to measure? How are we going to measure it? How are we going to use the data to improve conditions for providers and patients? These are the questions IT needs to be asking.

And for organizations currently working with EMR implementation and adoption, they need to be tracking data that will be meaningful to themselves and others who are not as far along the in the EMR adoption process. What can we learn from non-biased data gathering, from different hospital systems and HCO's who have adopted EMR? How long does productivity at the physician office level actually suffer? How has this impacted the system financially? How has it impacted patient wait times to get an appointment, or their hospitalization rates? (for chronically ill patients). These are the questions I find myself wanting answers to.

Anyway, thank you for writing a provocative article. Perhaps CMS has data on some of my questions, or there is some book or online source of information you can point me to to answer some of them. And perhaps I have given you some ideas for future articles that you can write, too. Thank you for making me think about it.
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