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Building a Data Analytics Infrastructure for ACO Development: Two Industry Expert Perspectives

June 7, 2014
by Kayt Sukel
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Capital Blue Cross’s Mark Caron and CBIG Consulting’s Todd Saunders share their perspectives on data analytics and ACOs

Today, more than 14 percent of the U.S. population is being served by an accountable care organization (ACO)—and that number is only expected to grow in the next decade.  The adoption of ACOs is meant to improve the quality of patient care while reducing costs.  To address the benefits, needs and challenges of ACOs, the Institute for Health Technology Transformation (iHT2) has tapped individuals experienced with successful ACO implementation for its “Population Health Management:  Enabling the Success of ACOs” panel, which will be held as part of the Health IT Summit in Denver, July 22-24. (iHT2). (Since December 2013, iHT2 has been in partnership with Healthcare Informatics, through its parent company, the Vendome Group, LLC.)

Mark Caron, senior vice president and CIO of the Harrisburg, Pa.-based Capital BlueCross, and Todd Saunders, principal consultant with the Rosemont, Ill.-based CBIG Consulting, two of the panelists, spoke with Healthcare Informatics regarding the key topics they plan to cover at this panel during the upcoming Denver Summit.

According to Saunders, an experienced healthcare IT consultant who has consulted with hospitals that are working through the beginning stages of ACOs, one of the biggest challenges to population health management is to get the right analytics in place.

“The whole point of an ACO is to improve outcomes and improve the overall health of the patient population,” he says.  “Given that, you need to be able to track outcomes—and track them in such a way where you can effectively prove benefit.  You need the right benchmarks and you have to be able to track them in real-time.”

Caron, whose group handles accountable care arrangements at Capital BlueCross, concurs—and says that deciding on the right analytics is often easier said than done. “Once you’ve seen one ACO, you’ve seen one ACO,” he says with a chuckle.  “Every organization is different.  Every patient is different.  And without real-time, perspective analytics to point physicians to care and identify places where they can improve care, it’s really hard to track those outcomes.  Right now, we don’t have longitudinal healthcare.  And we need long-term clinical measures and data to more clearly provide care and predict future issues.”

Mark Caron

But there needs to be more than just clinical data in the mix.  What also needs to be included in those analytics, Caron adds, is patient accountability.  “We talk all the time about holding physicians accountable.  And that’s important.  But what about the patients?  How do you hold a patient member accountable, help to make them more responsible in the accountable care structure?  I don’t think we’ve done much in our country on that front yet—and it means that our analytics are way behind.”

Caron says that technology can play a big role in getting that kind of patient engagement.  “There are all kinds of technologies out there that can keep them on track with a disease plan by reminding them of the kinds of food they should or shouldn’t eat, the appointments they have, that they should be exercising and just reminding them all-around to be more vigilant about caring for themselves.  And those technologies can provide data, too.”

Because of all the available information, Caron stresses that technology is going to play an increasingly important role in helping clinicians and care managers engage with patients—and improve the analytic capabilities that can make an ACO successful, too.  But, whenever you talk about large amounts of shared data, concerns about privacy and security come up.  Saunders says many of his clients worry about just how secure patient data can be in a shared structure.  But, he argues, as security practices are becoming more mature, hospitals should worry less.

“What it really comes down to is a willingness to participate fully, for all organizations in an ACO to be comfortable sharing their data,” he says.  “They have to be comfortable understanding that their data is leaving the premises and going to another location.  And, often, that takes a sort of sales effort—showing key stakeholders how it’s been done before—to make people comfortable.”

Both Caron and Saunders acknowledge that ACO implementation can seem pretty daunting—especially to smaller 300-bed and under hospitals.  But Saunders says that ACOs are an excellent way to address particular patient populations and get a more comprehensive view of the quality of care delivered. 

Still, Saunders says, organizations needs to be prepared to do the work.  They need full commitment and buy-in from both physicians and administration.  They need to be prepared to look at their organization from multiple angles so they can see how to get to a level of clinical integration and accountable care.  And, while no two ACOs are the same, hospitals can learn quite a bit from experienced partners who have put their own ACO structures in place.

Todd Saunders

“I hope that people understand that [ACO implementation] is too big to do alone.  It’s more than just a technology problem,” says Caron.  “The focus shouldn’t be so much on the financial aspects but on an assessment of the practices, the clinical delivery and an organization’s ability to make a drive towards various quality standards.  This is a ten year or more effort for our country.  And to get there, we need to stop trying to shoot for the sky and set real and attainable goals.”