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."