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Analytics for accountable care organizations
Short takes...on analytics
A blog by Tony Jurek, director, Deloitte Consulting LLP.
Analytics takes aim at accountable care organizations
As the health care industry shifts from volume to value based care models, payers and physicians are sharing the risks and accountable care organizations (ACOs) seek to deliver higher quality and satisfaction at lower costs (what the Institute for Healthcare Improvement calls the “Triple Aim”).
The Triple Aim tasks health systems with improving the patient care experience, the health of populations, while at the same time reducing the per-capital cost of health care. Meeting the Triple Aim objectives delivers potential benefits across the health care continuum and analytics is an essential capability for getting the job done. ACOs that strategically utilize analytics can better achieve the Triple Aim and experience an enhanced health system performance.
Where are the gaps? Data holds the answers
The expectation to help improve patient outcomes while reducing costs requires additional dependence upon data – and the insights hidden within it.
Today, analytics engines can combine large amounts of data from disparate systems, most of it gathered over the last 20 years of health care activities. By interpreting patterns in care, cost, community, and other data, health care professionals can construct a holistic view of the patient. There are several areas where analytics are empowering ACOs to better manage population health and spot gaps in care coordination and delivery, including the following:
- Customer segmentation: Preventing disease progression and driving appropriate utilization are ways ACOs can manage the health of a specific population – while potentially improving quality and cutting costs. Using descriptive analytics, ACOs can look at data over time to spot trends and gaps in population health. Populations can be segmented using filters, providing ACOs with insights on the entire population by payer, activity center, provider, and health condition(s). These insights enable ACOs to become more proactive in working towards improving population health management.
- Risk stratification: Today, ACOs assume most of the risks of understanding the patients they serve. Organizations that save money while meeting quality targets keep a larger part of the savings. But when an ACO is unable to save money, the costs of improvements and any resulting penalties land at the ACOs’ doorstep (downside-risk). ACOs can leverage predictive analytics capabilities to help identify high-risk segments, interpret the prevalence of health conditions, and evaluate provider and practice performance in those areas.
- Safety and quality reporting: Analytics enables quality reporting and compliance in new and different ways, bringing the detailed information ACOs require for operating, managing, and measuring performance. Specific analytics-driven reporting capabilities also support ACOs in meeting the CMS Physician Quality Reporting Initiative, the Medicare and Medicaid EHR incentive programs, health plan pay for performance programs, and patient-centered medical home recognition programs.
- Improved payer partnerships: Analytics can help ACOs leverage the relationships with health plans by measuring KPIs, including denial rates, take-back rates, claim and payment volumes, and outstanding receivables. In addition, the insights delivered from analytics can help ACOs identify fraud and abuse, as well as analyze and forecast costs and care utilization.
- Better cost management: With volumes of data now available to quantify the costs of common procedures, patients and physicians alike have new insights into the actual cost and profit of the services they use. Analytics supports the level of cost transparency key to preventing over-utilization of expensive or unnecessary services and empowers patients to make decisions about appropriate services.
Hitting the moving target
As the health care industry moves from volume-based to value-based care, analytics can deliver a new level of insight from the data ACOs already have – and from emerging data sources. To achieve today’s objectives and position within an industry in flux, ACOs can look to analytics to better understand, measure, and proactively address care and cost challenges while working towards improving patient satisfaction.