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Accountable Care

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Accountable Care Transformation Framework (Executive Report)

To succeed in a value-based care environment, accountable care organizations (ACO) require a solid foundation built on five competencies of population health management: infrastructure, population evaluation, provider network, quality and safety, and waste reduction. Once the foundation is built, the healthcare organization can package this “asset” to enter into truly beneficial agreements as outlined in this groundbreaking Accountable Care Transformation Framework.

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Accountable Care Organization Software: 5 Critical Information Systems

More and more, healthcare is molded and critically impacted by the software and information technology that surrounds and supports the industry. As a consequence, the C-level suite beyond the CIO must actively participate in the evolution of their organization’s IT strategy, particularly at the layer of technology where software directly supports workflows and business processes.There are five information systems that are indispensable to the success of an Accountable Care Organization (ACO). Those five critical information systems are 1) An Electronic Medical Record (EMR), 2) A Health Information Exchange (HIE), 3) An Activity Based Costing (ABC) system, 4) A Patient Reported Outcomes (PRO) system, and 5) An Enterprise Data Warehouse (EDW).

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Why Pioneer ACOs Are Disappearing and 3 Trends to Expect from the Exodus

Over half the Pioneer ACOs have dropped from the program in the last four years, despite achieving $304 million in savings, and fifty percent of the participating ACOs receiving shared savings reimbursements. Why the exodus? Overutilization and inconsistent performance benchmarking and attribution hindered the ability of many participants to achieve success. The overall impact of the program, however, has been a positive one for value-based care. In the next 3-5 years, providers and health systems will bear more of the financial risk of the populations they serve. The proliferation of data, and the tools to analyze and exchange it, will be critical to the long-term success of value-based care.

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Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings Program

A series of revolutions has driven the development of the U.S. healthcare system, enabling dramatic improvements in all aspects of healthcare quality and outcomes over the past century. Although healthcare organizations have focused on moving towards value-based care for decades, the data shows that the shift is indeed taking place and fee-for-service models are declining. New changes to the Medicare Shared Savings Program (MSSP) will help drive this change as revisions to MSSP require ACOs to take on more financial risk earlier. This article covers the following topics:

  1. Important moments in history that led to today’s current challenges.
  2. Why financial imperatives drive cultural change in our economic model.
  3. Ways MSSP can help healthcare organizations achieve financial success.
  4. How to utilize data to develop better healthcare delivery systems.

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ACOs and CINs: Past, Present, and Future

Accountable Care Organizations (ACOs) and clinically integrated networks (CINs) are two types of organizations working to address the problem of rising costs. As ACOs and CINs continue to evolve, organizations moving into value-based care (VBC) face an ever-changing landscape. This article looks at the evolution of the ACO and CIN models, what new tools ACOs employ today to promote success, and lessons learned from organizations that have succeeded in alternative payment models. It also explores what healthcare experts believe the future of alternative payment models will look like and competencies to develop to meet those changing demands.

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Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics

A hot topic in healthcare right now, especially in the medical coding world is the Hierarchical Condition Category (HCC) risk adjustment model and how accurate coding affects healthcare organizations’ reimbursement. With almost one third of Medicare beneficiaries enrolled in Medicare Advantage plans, it’s more important than ever for healthcare organizations to pay attention to this model and make sure physicians are coding diagnoses appropriately to ensure fair compensation. This article walks through basics of the risk adjustment model, why coding accuracy is so important, and five action items for interdisciplinary work groups to take. They include:

  1. Having an accurate problem list.
  2. Ensuring patients are seen in each calendar year.
  3. Improving decision support and EMR optimization.
  4. Widespread education and communication.
  5. Tracking performance and identifying opportunities.

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ACOs: Four Ways Technology Contributes to Success

With an increasing emphasis on value-based care, Accountable Care Organizations (ACOs) are here to stay. In an ACO, healthcare providers and hospitals come together with the shared goals of reducing costs and increasing patient satisfaction by providing high-quality coordinated healthcare to Medicare patients. However, many ACOs lack direction and experience difficulty understanding how to use data to improve care. Implementing a robust data analytics system to automate the process of data gathering and analysis as well as aligning data with ACO quality reporting measures. The article walks through four keys to effectively implementing technology for ACO success:

  1. Build a data repository with an analytics platform.
  2. Bring data to the point of care.
  3. Analyze claims data, identify outliers, including successes and failures.
  4. Combine clinical claims, and quality data to identify opportunities for improvement.

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Population Health Documentary Highlights Three Success Stories Transforming Healthcare

The documentary, “A Coalition of the Willing: Data-Driven Population Health and Complex Care Innovation in Low-Income Communities” shows how precision medicine and care management can be effective tools for successful population health. The film highlights three programs that use data to hotspot populations of high-risk, high-need patients, and then deploy unique, targeted care management inventions. The documentary, which initially aired during the 2017 Healthcare Analytics Summit, presents hopeful solutions, scalable across diverse patient populations, that are leading to exceptional results and the future of healthcare transformation.

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Understanding Risk Stratification, Comorbidities, and the Future of Healthcare

Risk stratification is essential to effective population health management. To know which patients require what level of care, a platform for separating patients into high-risk, low-risk, and rising-risk is necessary. Several methods for stratifying a population by risk include: Hierarchical Condition Categories (HCCs), Adjusted Clinical Groups (ACG), Elder Risk Assessment (ERA), Chronic Comorbidity Count (CCC), Minnesota Tiering, and Charlson Comorbidity Measure. At Health Catalyst, we use an analytics application called the Risk Model Analyzer to stratify patients into risk categories. This becomes a powerful tool for filtering populations to find higher-risk patients.

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Why Pioneer ACOs Are Disappearing and 3 Trends to Expect from the Exodus

Over half the Pioneer ACOs have dropped from the program in the last four years, despite achieving $304 million in savings, and fifty percent of the participating ACOs receiving shared savings reimbursements. Why the exodus? Overutilization and inconsistent performance benchmarking and attribution hindered the ability of many participants to achieve success. The overall impact of the program, however, has been a positive one for value-based care. In the next 3-5 years, providers and health systems will bear more of the financial risk of the populations they serve. The proliferation of data, and the tools to analyze and exchange it, will be critical to the long-term success of value-based care.

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A Guide to Governing Healthcare Claims Data Successfully: Lessons from OSF HealthCare

OSF HealthCare has committed that 75 percent of its primary care patient will be part of a value-based program by 2020. The organization’s leaders knew that success depended on how well they managed their data and decided to build a data warehouse in-house. They recognized that beneficiary claims data was essential to understanding their population better. To get that claims data, however, was no easy task. This required patient matching through master data management and getting buy-in from leaders and physicians throughout the health system. Then, they prioritize where to start efforts using the 80/20 rule and using that as a guide, loaded the claims data.

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5 Ways to Mitigate ACO Risk Using Analytics

Many healthcare organizations seem to have been in perpetual pilot stage while experimenting with value-based payment models. Healthcare organizations are focusing their efforts in two primary areas: developing the skills to successfully manage at-risk contracts and, preparing for the considerable business and care delivery transformation necessary for true population health management. But what are the foundational competencies needed to take on risk?  Healthcare organizations should consider the following 5 key areas:  1) at-risk contract management, 2) network management, 3) care management, 4) performance monitoring, and 5) improvement prioritization.  The value of analytics in each of these competency areas is to prioritize limited resources on the highest impact area.

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Data Management and Healthcare: Why Databases and EMRs Don’t Make the Cut on Their Own

Healthcare organizations preparing for the value-based payment model shift have found their internal resources pushed to the limit. Often, in an attempt to address regulatory timetables, systems will use point solutions rather than move toward a long-term strategy of developing robust clinical analytics. If an organization is using their EHR for analytics, they will soon discover that these built-in analytics packages cannot help them identify opportunities for cost effectiveness and clinical best practices. Sophisticated data management and healthcare analytics solutions, however, can provide leaders with the integrated clinical, financial, and patient satisfaction data they need to transform their systems into data-driven enterprises.

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What is an Accountable Care Organization (ACO)?

The ACO concept can be generically defined as a group of health care providers, potentially including doctors, hospitals, health plans and other health care constituents, who voluntarily come together to provide coordinated high-quality care to populations of patients  This article, written by two physician executives with years of accountable care experience, gives a robust overview of the ACO concept including:  the history, range of payment models, the new accountability and payment structures, a comparison between traditional insurance vs ACO models, key barriers and challenges, and most importantly, the key criteria needed for ACO success.

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ACO Success Requires Precise Patient Population Definitions

An ACO will fail without precise patient population definitions. ACOs need to define populations for many reasons, including identifying their members and attributing those patients to the correct physician and performing population health analytics. The challenges to a good population definition are: multiple providers per member, multiple data sources, and multiple identifiers for each member. Using a clinical integration hierarchy to refine population and subpopulations will solve a lot of these issues. A data warehouse is the foundation that makes it possible.

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The Key to ACO and Value-based Purchasing Success: Lowering Cost Structure

Health systems and large physician groups will need to focus on lowering their cost structures to survive in a value-based future. To succeed, systems must understand their cost structures on a granular level. Only at this detailed view can they identify variation, find the causes for it, and fix it. An enterprise data warehouse provides the platform for aggregating data from clinical and financial system into usable analytics.

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Meaningful Use and ACO Reporting: Why an EMR Is Only a Partial Solution

Meaningful Use and ACO reports are just two of a plethora of ever-increasing external healthcare reporting requirements. An EMR is only a partial solution due to limitations in data turnaround time, data and logic multi-purposing, and being relegated to single-vendor, homogenous environments. Learn about a solution that helps you streamline your Meaningful Use and reporting requirements and can be leveraged for clinical quality improvement, population health and predictive analytics.

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Key Things to Look for in an ACO Analytics Solution

The best solution for leveraging data to drive clinical and financial improvement in an ACO environment is a healthcare enterprise data warehouse (EDW) with a flexible, Late-Binding™ architecture. Why? Because a successful analytics solution for an ACO must be one that: i. 1. Gives rapid time-to-value. ii. 2. Adapts easily to the changing needs of an organization.

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Accountable Care Means Sharing Data Between Payers and Providers: You’ll Need More than an EHR

Accountable care is changing the way Payers and Providers look at their healthcare data. Many healthcare enterprises believed that their Electronic Health Record (EHR) would be the silver bullet to this data problem, but they are beginning to discover the limitations of the EHR for managing at the enterprise-level all of the information necessary for effective risk-sharing. Health information exchanges (HIEs) help eliminate data silos but are not designed to store or analyze the data with the level of sophistication required for supporting a risk-sharing model. The reality is, until now, providers and payers have lacked consistent incentives to share data.

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