EagleDream Health – Don’t Let Insufficient Data Analytics Impair Your ACO’s Financial and Clinical Performance
In an article titled Insufficient IT and Analytics Capabilities Are Seen as Barriers to ACO Success: AMGA Survey, published in Healthcare Informatics, Mark Hagland reports that ACO leaders are identifying “insufficient IT and analytics capabilities” as major barriers to take on financial risk in risk-based contracts with either the federal government or commercial insurers. While the percentages of patients are included in Medicare Pioneer ACO, Shared Savings programs or Next-Generation ACO programs are growing, and commercial ACO programs are increasing as well, ACO leaders are disappointed with the data they are receiving. Specifically, they are disappointed with their ability to convert the data to usable formats that provide easy to understand actionable reports to their administrators and practitioners.
This need for useful data is addressed in an American Journal of Managed Care article by Beckman, Healey and Gelb Safran. The article, Improving Partnerships Between Health Plans and Medical Groups, provides some direction in how to build more effective risk-contracting relationships. One of the three factors critical to success is Collecting and Using Data to Improve Outcomes. In fact, the data needed to manage risk is available currently in the insurer’s claims data and in practice’s EMRs. The difficulty most have is either 1) obtaining the data from the payers, 2) organizing the data into usable, actionable data sets for administrators and practitioners, and 3) integrating quality data into the cost equation to ensure the elimination of low value care and the provision of high value services.
Towards that end, EagleDream Health has developed a software solution available to ACOs and health delivery systems that address these concerns. In its’ PERFORM module, EDH integrates and analyzes risk adjusted EMR data to provide actionable comparative data to practitioners and care managers that identifies needed and near-needed services, practice demographics and progress toward achieving shared savings program goals. At the same time, the PERFORM module uses claims data to identify high cost high volume conditions and identify the clinical cost drivers for those conditions. With that information, EDH can identify variation in the use of those clinical cost driver services allowing practice groups to address both overuse and underuse of services.
At the same time, using this performance data, PERFORM helps ACO administrators address network design and performance issues by knowing which practices refer out of network and to whom they refer. Data on the cost per episode of care for both in and out of network practices, and geographic analysis to determine next steps in improving outcomes and network design.
Contact EagleDream Health today to learn more about our software solutions.