With recognition that "the path through accountable care is unknown," IDC Health Insights has launched a new Accountable Care Maturity Model, designed to help healthcare organizations gauge their own status and make strategic decisions for funding business and IT initiatives.
Like those newish technologies, "accountable care is an early stage market," writes Cynthia Burghard, IDC research director, in the report. "Many healthcare organizations participate in accountable care without a long-range or midterm strategy or explicit goals. As a result, many organizations are floundering and are unsure of their next steps."
IDC's Accountable Care Maturity Model identifies five stages for organizations feeling their way through this new reimbursement landscape.
- Ad Hoc. These organizations have typically launched pilot projects or proof of concept – more or less "business as usual with some changes in reimbursement to encourage and reward providers for meeting or exceeding performance goals," Burghard writes.
- Opportunistic. In this stage, healthcare organizations are game for accountable care programs offered by an external third parties,but still have not launched initiatives of their own. "Upside risk gets introduced into reimbursement approaches, and funding for programs comes from individual practices or departments," according to the report.
- Repeatable. By the third stage, "funding and budgeting for accountable care programs are secured and an advisory board is formed to provide guidance on clinical program design and financial management. Healthcare organizations accept both upside and downside risk, and care management becomes more proactive," Burghard writes. "Data becomes crucial at this stage and results in the introduction of new data sources such as unstructured clinical data." As such, this is where investments must be made in analytics, workflow and patient engagement technologies.
- Managed. At this point, organization have implemented a formal staffed and funded management structure and are actively seeking ACO contracts. "Accountable care becomes strategic and key to the growth of the organization," according to the report, and IT capabilities have been "consolidated on a single platform or are fully integrated. The mobile device channel becomes widespread for patient engagement."
- Optimized. At the pinnacle of the maturity model, there's "a culture of proactive coordinated care and the acceptance of upside and downside risk," writes Burghard. "Organizations will have 50–65 percent of their revenue from risk-based contracts." By this point, "the critical value of information in the management of accountable care is well understood and results in access to multiple data sources such as streaming data, mobile sensors, and unstructured data. Ubiquitous role-based access to data is accomplished. Technology investments include advanced analytics and technology to support large volumes and varieties of data."
As part of the model, there are also five measurements – intent, data, technology, people and process – for which IDC suggests benchmarks based on short-term progress (12–24 months) and longterm progress (24–36 months).
It is, after all, a long process. And often an arduous one, which requires adopting new capabilities and completely rethinking of long-ingrained ways of doing business.
[See also: ACOs don't have to be daunting, according to experts ]
"Change management is one of the greatest challenges," on the path to accountable care, Burghard tells Healthcare IT News. "Providers are not familiar with the concepts of population health management, which is why the maturity model includes five measures, as the transition from pay-for-volume to pay-for-value requires changes across the enterprise. Each of the five measures is critical and technology is the enabler of many of these changes."
At this early stage, "unfortunately many providers still believe that all they need is an electronic health record," she says. "The analytics, workflow and patient engagement technologies that are required for population health management are new to most provider organizations."
[See also: ACOs need 'more' than an EMR]
As organizations dip their toes in the water of accountable care, familiarizing themselves with these new species of health IT, it is critical for them "to have a strategy for their accountable care transition before technology is procured," says Burghard. "Once the business strategy is in place the organizations can develop a technology procurement and deployment strategy. It is an early stage market so healthcare organizations must remain flexible."
Learn more here.