Plotting the ACO roadmap: Leveraging the appropriate technology

Technology can help ACOs efficiently identify at-risk patients and proactively transition them into cost-effective care.
By Robert Dichter
08:54 AM

In part one of this series, we discussed thinking about becoming an ACO and the strategic foundation necessary to accomplish that. In part two, we discussed how patient engagement is another important element of successful ACOs. In this third installment, we'll look at ACOs from a technology perspective.

Launching and sustaining an accountable care organization (ACO) without robust technology is like building a house without power tools. It can be done, but it will take a lot of time and resources to accomplish. Furthermore, the final product may not be as good--or sophisticated--as it could be.

Technology, including electronic health records; data acquisition, aggregation, and normalization; financial and clinical analytics; patient engagement applications; and care management software (collectively called population health management solutions), can help ACOs efficiently identify at-risk patients and proactively transition them into cost-effective care--activities that are essential to any well-performing operation. These solutions can also enable more accurate and streamlined quality and cost reporting. Without such automated tools, an ACO may miss opportunities, overlooking potential risks and falling short in managing the health and care costs of a designated population.

What Kind of Technology is Necessary?

Once an ACO appreciates the need for technology, it must consider what capabilities will drive optimal performance based on its overarching goals and metrics it's expected to meet. Following are a few key features to keep in mind:

·       Interoperability. A solution that seamlessly shares information across the care continuum can ensure ACO staff have all the necessary information to successfully manage patient care. When clinicians look at a longitudinal patient record, they are able to see a comprehensive view of a patient's health and treatment history, regardless of where the patient received care. Without this type of interoperable record, an ACO may miss opportunities to improve care plans or make decisions based on incomplete information. Both of these issues can limit its ability to improve outcomes while decreasing costs.   

o   One simple example that have plagued primary care providers for years is what happened to their patient when they went to the hospital or specialist.  Did the patient actually see the specialist?  Was there a change in treatment or a change in medications?  Not having a complete longitudinal medical record will hamper the ability to make accurate medical decisions on behalf of the patient.

·       Analytics. To discover patients in greatest need for care, an ACO should employ technology with robust analytics. Having strong analytics capabilities lets an ACO slice and dice patient information to uncover risk.

o   For example, ACOs can leverage data analytics to pinpoint chronic condition patients who have not seen a physician in more than a year.

o   Or, maybe the organization wants to reduce unnecessary emergency department (ED) visits and searches for patients who have gone to the ED more than twice in the past six months.

Alternatively, identify those patients that have had "never" events – i.e. diabetics that aren't being managed sufficiently in the community that needed a hospitalization that "never" should have occured.  Finding these patients and targeting them proactively for earlier interventions and care monitoring, promotes both better quality care and reduced utilization of high cost treatments, such as hospitalizations and ED visits, resulting in lower cost.

·       Care management. Once an ACO has identified its at-risk patients, it needs a solution that enables efficient connections with targeted individuals. Having such technology allows staff to transition these patients into appropriate care management programs, keep track of their health between care visits, provide education and engage those patients in their own care plan. 

o   One simple patient engagement strategy is provide an automated outreach to those patients that have missed a clinical care guideline and encourage them to come back into the practice and "get them back on track." 

o   As most chronic disease patients are only seen in the office a few times a year, an effective care management solution will enable the practice to keep better tabs on their patients, identify those at risk, and intervene early if their health seems to be deteriorating.

·       Clinical and financial data integration. To remain afloat, ACOs must not only elevate patient outcomes, but also manage costs. By using technology that merges clinical and financial information, an ACO can determine where patients are receiving care and how much that care costs. This helps to uncover opportunities for improvement. For example, when reviewing data from integrated technology, if staff notice that a provider's patients are going to the emergency department on the day the provider's office is closed, the ACO may want to offer a less expensive alternative for patients needing medical attention when the PCP is unavailable. Similarly, if staff discover patients are going out of network to receive a certain type of specialty care, the ACO may want to think about adding that kind of specialist to keep patients in network.  One simple example is an ACO that notices that much of its out of network spend is on radiology procedures – this might provide the impetus to build a radiology center and better manage that spend.

·       Contract guidance. By using a contracting solution, ACOs can set themselves up for success, ensuring that public and private contracts adequately define achievable goals, protect organization interests and appropriately reward the ACO for assuming risk.

Make sure technology matches risk tolerance

Although the abovementioned features are critical for supporting an ACO, an organization should not just adopt technology solutions wholesale. Depending on the business goals of the ACO and the amount of risk the organization is comfortable taking on, the sophistication and specific features of the technology will vary.

Before purchasing any solutions, organization leaders should sit down together and determine the amount of risk the ACO is willing to accept and what level of technology will be required to manage that risk. If an organization is merely dipping its toes in ACO waters, for instance, it may not need a comprehensive set of solutions. It could start with its current electronic health record and a spreadsheet that houses claims information from a payer.

However, if the organization wants to jump both feet into the ACO world, it should consider implementing technology that has all the latest features, whether that takes the form of a single platform or a series of add on solutions. In some cases, organizations may even want to outsource particular tasks, relying on third-party experts to leverage cutting edge technology to manage risk.

The technology-enabled ACO

Regardless of an organization's approach to ACO technology one thing is clear. By embracing automated solutions in some form, an ACO will better position itself to effectively managing risk, caring for patients and keeping costs in check.