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Do Accountable Care Organizations Improve Patient Care?

Report suggests ACOs may improve quality of care and drive down costs, but analysis calls that conclusion into question.

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Cigna's collaborative accountable care (CAC) model revealed "favorable trends in total medical costs and quality of care," according to a recent report published in Health Affairs. But despite the positive interpretation of the data by the authors, which included a Cigna executive, the Health Affairs report wasn't able to show statistically significant results.

The study reported interim quality and cost results from three physician practices in Arizona, New Hampshire and Texas. According to the company release, results suggest that a shared savings accountable care model, with support from the payer, can help physician practices take steps toward "full accountability for care and efficiency."

The study reviewed the results of providing financial incentives to physician groups and integrated delivery systems in an effort to improve the quality and efficiency of care for patients in commercial, open-access benefit plans. Nurses serving as care coordinators played a key part in the initiative and used patient-specific reports and practice performance reports to "improve care coordination, identify and close care gaps, and address other opportunities for quality improvement."

[ For the latest development on Meaningful Use, see Meaningful Use Stage 2 Rules Finalized. ]

According to the report, the results weren't statistically significant, which is another way of saying these findings could be coincidental. Nevertheless, Paul Oates, senior enterprise architect at Cigna, told InformationWeek Healthcare that the use of analytics and informatics can help prove the effectiveness of this model and others like it.

"There are…analytics and informatics components that are important to power these innovations," he said. "Often, the discussion starts with health information exchange and electronic medical record connectivity, which are really hot right now. But what's important first, we found, was doing a good job with the informatics and analytics required to create actionable information."

According to Oates, when conducting the study Cigna spent time with back-end analytics that are needed to "drive and create actionable information that's of value."

Oates continued, "... physician practices and integrated delivery systems have data that's an inch wide and a mile deep; they have deep information about a patient because of the clinical record.... The health plan or intermediary role has data that's a mild wide and an inch deep; they know every test and procedure because they were paid for."

The key is to put those two together, Oates explained, so practices have a complete picture of all the patient's information. From there, they can put that information together "so you can find the top 10 diabetic people who were discharged yesterday that need a follow-up visit, for example." Oates said, "That's not big data -- that's good, old fashioned blocking and tackling. That's where it begins, and for some of us, that's sexy because putting that data together and making it actionable is extremely helpful to a physician practice."

The "IT message," Oates concluded, is doing the analytics to create integrated data.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)

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User Rank: Apprentice
11/27/2012 | 7:38:11 AM
re: Do Accountable Care Organizations Improve Patient Care?
I'd be interested in seeing more information to back up the CAC model. This sample/study seems to be a little small, with only 3 practices being sampled, but it seems reasonable that other studies would back up these findings.

Jay Simmons
Information Week Contributor
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