On Monday, Jan. 11, the federal Centers for Medicare & Medicaid Services (CMS) fully unveiled the new Next Generation ACO program, revealing both the details of the program’s parameters, and the list of 21 accountable care organizations (ACOs) that had joined the program, which was officially fully launched on Jan. 1.
As noted in this publication’s report on the unveiling on Monday, the Next Generation ACO Program now joints the Pioneer ACO Program and the Medicare Shared Savings Program (MSSP) as programs that patient care organizations nationwide can join and participate in, around accountable care concepts and principles.
Among those closely tracking all the CMS-sponsored ACO programs are senior leaders at The Advisory Board Company, the Washington, D.C.-based research, technology, and consulting firm. Last week, HCI Editor-in-Chief spoke first to Rob Lazerow, the organization’s practice manager, Research and Insights, for his perspectives on the overall strategic issues facing the developers of accountable care organizations sponsored by CMS. Hagland then spoke with Nicole Latimer, The Advisory Board Company’s senior vice president, Performance Technologies, to get a sense of the broad strategic IT issues facing ACO leaders. Below are excerpts from that interview.
People often understand the very broadest strategic concepts around accountable care, but their implementation/execution is so much more difficult in practice, correct?
Yes. And when I look at the introduction of the Next Generation ACO Program, I agree with Rob [Lazerow] that it’s great that providers are getting greater flexibility. And it’s great that they have more flexibility about what they’re going to put into place and how they’re going to do it. On the other hand, because there are greater risks and rewards involved, there’s going to need to be much greater rigor and precision around the use of data. To get those greater rewards, you’ll need to be very effectively manage your cost of care, and to coordinate care. There aren’t a lot of financial incentives for Medicare patients to stay inside a network, so it’s going to be up to the network to keep them in. And that coordination will include the sharing of patient records to see where the patient has been and what kinds of services they’ve received.
And lastly, how do you use your data to improve access? Because if your patient can’t get in to see a provider in a timely manner, they’re going to go somewhere else. So for me, I think implementation starts with making sure that your existing data sources are well-used and accurate. Particularly around costs, we see a lot of organizations that don’t have a robust cost accounting system; and they can’t get to accurate cost per case, cost per episode, or cost per patient. So if you don’t have a good sense of your costs right now—your first step is figuring out, do I need a new cost accounting system? How will I implement that system? And how will I change clinical workflows to capture costs? Because right now, some of those costs are captured when nurses scan medications and add those scans to the chart, and somebody adds those to your bill. If there’s a more automated way to do that, you won’t need people having to go into every chart to scan those items into it.
Marrying clinical and claims data and analyzing the data, is difficult, correct? Even with prospective attribution now under the Next Generation ACO Program?
Yes, it’s definitely difficult, along multiple dimensions. First is the difficulty involved in the actual physical matching of clinical and claims data—you have to make sure you’re matching the right data for the right Mrs. Smith. We have a patient-matching algorithm that requires 12 separate elements need to create a match; and I’m sure others have other algorithms. And those algorithms need to be made more sophisticated and successful.
Then, once the data is merged, it’s hard to figure out what I should be looking for, absent a ton of knowledge about specific disease states. The classic area we talk about is heart failure readmissions. The first thing an emergency physician or cardiologist would ask is, what is the patient’s ejection fraction?—basically, the percentage of blood ejected out of the ventricle when your heart pumps.
And you may not even know that, right?
Yes, because ejection fractions are usually calculated through a test conducted in a cardiologist’s office. And you’ve got to be able to grab that information from the continuum. You’ve actually got to go out and get the data from the entire network, to get the most comprehensive view of the patient.
What are the big challenges providers face in tracking that data down?