[{"innerBlocks":[],"name":"core\/freeform","postId":126654,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Accountable care organizations (ACOs) are on the forefront of the drive toward shared risk, value-based healthcare. They are also on the front lines of determining how to best deliver and prove that value.

The Centers for Medicare and Medicaid Services set a goal to have 50 percent of Medicare recipients in an ACO or other alternate payment models by 2018. Based on history, private payers will likely follow.

It\u2019s hard to discuss today\u2019s various ACO models without looking back to the failed health maintenance organizations of the 1980s and 1990s. Many of those plans relied on capitation, which sets a fixed amount of provider revenue per member, with little alignment on improved quality or outcomes.

This tended to reduce service levels, with a laser focus on the bottom line and little regard for each member\u2019s clinical outcomes and experience. By the late 1990s, studies showed almost a third of HMO members weren\u2019t satisfied with their plans\u2019 \u201ctimeliness, professionalism or accuracy.\u201d

Combined with a misalignment of provider incentives, capitation-based models frankly failed because of a lack of robust, near real-time data and user-friendly tools that could give providers actionable information to help determine which services were most effective. Not that it mattered, in most cases; few HMOs had the right staff to develop and utilize individualized care plans down to the member level that could achieve the critical cost-quality balance.

Thankfully, that\u2019s changing. Today\u2019s ACOs can have volumes of data from multiple sources at their disposal, with intuitive analytical tools that can present it in a way providers can actually use. This information down to the member level can finally help us achieve 21st century healthcare\u2019s Holy Grail\u2014the triple aim goal of improving clinical outcomes, cost efficiency and the consumer experience.

Significant progress in harnessing the power of big data has been made, but work remains. ACOs\u2014typically large, diverse organizations\u2014have even more relevant data than most. They also face more challenges to use it effectively because of the many electronic health record and other systems, even paper records, from which it comes. An ACO must agree on what data is most relevant and how to best gather and analyze it; it needs to transform that data into actionable information that fuels the actions which will have the greatest impact on each member\u2019s health.

Unfortunately, many organizations, including some ACOs, still use data from limited sources\u2014primarily retrospective claims and an initial assessment call focused on a member\u2019s primary condition. Healthcare consumers don\u2019t like this long call\u2014providing information they\u2019re frequently asked to repeat later\u2014and even hang up before it\u2019s completed, further limiting available data. Can you blame them?

Then, typically, providers pull a one-size-fits-all care plan\u2014usually focused on the Core 5 conditions of CHF, COPD, CAD, asthma or diabetes\u2014off the shelf, assign a care manager and begin standard interventions for that condition\u2014not that individual.

Leading-edge ACOs and other risk-bearing organizations are learning to improve overall population health, one unique member at a time. This represents a paradigm shift in care management and starts by capturing the most salient data to maximize targeting those with the highest impact.

This transcends conditions to precision-target members who will most benefit from personalized interventions, and then matching resources to the member\u2019s needs and personality to optimize outcomes. Whether those needs are poor adherence to their treatment plan, lack of transportation, behavioral health issues or other factors, today\u2019s innovative care management services can help organizations overcome barriers that increase risk and obstruct the ability to effect change.

Advanced analytics, such as biometrics, symptoms, lab, pharmacy, and claims, can effectively and continually process data to create a 360-degree view of the member. This provides actionable insights and a timely focus showing where opportunity exists for sustainable health improvement, cost savings and an improved customer experience for each member.

The ACO can develop an individualized care plan and match a member to a multi-disciplinary, condition-agnostic team that has the right mix of skills and personalities to meet the member\u2019s clinical, behavioral and environmental needs. Frequent, brief \u201ctouch points\u201d with the member and his or her care circle by phone, email or text continuously adds to the body of knowledge; together, this enables the team to guide a member down a clear path toward optional health outcomes, which in turn lower costs and improve satisfaction. Triple aim goals: achieved.

Armed with the right actionable information and a flexible, personalized member care plan and team, accountable care organizations have an incredible power to positively impact clinical outcomes, cost and satisfaction. If implemented correctly, ACOs will play a critical role in transforming our care-delivery system and the value we derive from it.","saveContent":"Accountable care organizations (ACOs) are on the forefront of the drive toward shared risk, value-based healthcare. They are also on the front lines of determining how to best deliver and prove that value.

The Centers for Medicare and Medicaid Services set a goal to have 50 percent of Medicare recipients in an ACO or other alternate payment models by 2018. Based on history, private payers will likely follow.

It\u2019s hard to discuss today\u2019s various ACO models without looking back to the failed health maintenance organizations of the 1980s and 1990s. Many of those plans relied on capitation, which sets a fixed amount of provider revenue per member, with little alignment on improved quality or outcomes.

This tended to reduce service levels, with a laser focus on the bottom line and little regard for each member\u2019s clinical outcomes and experience. By the late 1990s, studies showed almost a third of HMO members weren\u2019t satisfied with their plans\u2019 \u201ctimeliness, professionalism or accuracy.\u201d

Combined with a misalignment of provider incentives, capitation-based models frankly failed because of a lack of robust, near real-time data and user-friendly tools that could give providers actionable information to help determine which services were most effective. Not that it mattered, in most cases; few HMOs had the right staff to develop and utilize individualized care plans down to the member level that could achieve the critical cost-quality balance.

Thankfully, that\u2019s changing. Today\u2019s ACOs can have volumes of data from multiple sources at their disposal, with intuitive analytical tools that can present it in a way providers can actually use. This information down to the member level can finally help us achieve 21st century healthcare\u2019s Holy Grail\u2014the triple aim goal of improving clinical outcomes, cost efficiency and the consumer experience.

Significant progress in harnessing the power of big data has been made, but work remains. ACOs\u2014typically large, diverse organizations\u2014have even more relevant data than most. They also face more challenges to use it effectively because of the many electronic health record and other systems, even paper records, from which it comes. An ACO must agree on what data is most relevant and how to best gather and analyze it; it needs to transform that data into actionable information that fuels the actions which will have the greatest impact on each member\u2019s health.

Unfortunately, many organizations, including some ACOs, still use data from limited sources\u2014primarily retrospective claims and an initial assessment call focused on a member\u2019s primary condition. Healthcare consumers don\u2019t like this long call\u2014providing information they\u2019re frequently asked to repeat later\u2014and even hang up before it\u2019s completed, further limiting available data. Can you blame them?

Then, typically, providers pull a one-size-fits-all care plan\u2014usually focused on the Core 5 conditions of CHF, COPD, CAD, asthma or diabetes\u2014off the shelf, assign a care manager and begin standard interventions for that condition\u2014not that individual.

Leading-edge ACOs and other risk-bearing organizations are learning to improve overall population health, one unique member at a time. This represents a paradigm shift in care management and starts by capturing the most salient data to maximize targeting those with the highest impact.

This transcends conditions to precision-target members who will most benefit from personalized interventions, and then matching resources to the member\u2019s needs and personality to optimize outcomes. Whether those needs are poor adherence to their treatment plan, lack of transportation, behavioral health issues or other factors, today\u2019s innovative care management services can help organizations overcome barriers that increase risk and obstruct the ability to effect change.

Advanced analytics, such as biometrics, symptoms, lab, pharmacy, and claims, can effectively and continually process data to create a 360-degree view of the member. This provides actionable insights and a timely focus showing where opportunity exists for sustainable health improvement, cost savings and an improved customer experience for each member.

The ACO can develop an individualized care plan and match a member to a multi-disciplinary, condition-agnostic team that has the right mix of skills and personalities to meet the member\u2019s clinical, behavioral and environmental needs. Frequent, brief \u201ctouch points\u201d with the member and his or her care circle by phone, email or text continuously adds to the body of knowledge; together, this enables the team to guide a member down a clear path toward optional health outcomes, which in turn lower costs and improve satisfaction. Triple aim goals: achieved.

Armed with the right actionable information and a flexible, personalized member care plan and team, accountable care organizations have an incredible power to positively impact clinical outcomes, cost and satisfaction. If implemented correctly, ACOs will play a critical role in transforming our care-delivery system and the value we derive from it.","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Why ACOs must leverage big data to succeed

More for you