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Of Musical Scores and ACOs

May 15, 2012
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The best accountable care organizations will be directed through IS

There are few things more inspiring than the parts of a talented orchestra coming together to create beautiful piece of music. Whether it’s a classic like Beethoven’s “Symphony No. 5 in C Minor,” a patriotic work like “Stars and Stripes Forever” or the unforgettable main theme to Star Wars, an orchestral music performance is the work of many pieces coming together in harmony through the work of a singular person and item: the conductor and their score.

Like an orchestra, there are many elements to a successful accountable care organization (ACO): care coordination between providers, near-real-time patient information, reporting analytics, patient engagement, physician-hospital alignment, and care prevention, all of which are just a few of the basics. All of these things are interconnected and it seems care providers, more than ever, are looking at information systems as a way to bring them all together for a successful ACO implementation. In one way, information systems are to an ACO what the conductor’s score is to an orchestra.

Take Banner Health for instance, the Phoenix-based non-profit healthcare system with 23 hospitals spanning multiple states, recently announced a partnership with Hartford, Conn.-based Aetna, a nationwide health insurer. Aetna will supply a “technology stack” for population health management and patient services for more than 200,000 Banner patients. Separately, Banner was selected by the Centers for Medicare and Medicaid Services (CMS) as one of the first Pioneer ACOs.

The original announcement between Banner and Aetna was the creation of an ACO through a health insurance plan called Aetna Whole Health. Those patients and the 50,000 Medicare fee-for-service patients will get the benefit of a health information exchange (HIE) through Medicity (Salt Lake City, Utah), online appointment setting through iTriage (Lakewood, Colo.), and a clinical decision support  (CDS) and a desktop-based workflow tool through Active Health Management (New York City) for tracking and monitoring.

In announcing the partnership, Tricia Nguyen, M.D., CMO for Banner, said something poignant in my opinion. She said the traditional EMR has limited value in “providing the level of clinical insights needed to succeed” in ACOs. Essentially, the more proven clinical technology you have, the better the score will be.

I like this idea. Recently, I got the chance to talk with James McGee, M.D., an assistant dean for medical education technology at University of Pittsburgh School of Medicine, about the topic of patient simulations. Patient simulations are a web-enabled software solution that allows for diagnostic simulated training. Used for many years as a tool to teach medical students, McGee sees it as an ideal instrument for an ACO.

James McGee, M.D.

McGee says the shift to an evidence-based healthcare culture will mean getting away from a “one-sized fits all mode for clinical decision-making,” and a transition to complex decision-making scenarios. Patient simulation, he says, “Focuses on training you to be able to better take the unique data from that particular patient and synthesize that information with the healthcare environment you are working in.” An active learning experience like this, he says, “Can actually translate new skills to the real world and see improvements in performance.”

There are several good use cases of patient simulation out there, currently including Banner Health’s Banner Simulation Medical Center, Duke University’s Human Simulation and Patient Safety Center, and a recently introduced program through the Veterans Health Administration.

In my interview, McGee accurately pointed out the barriers all technology leaders at hospitals are going to inevitably face when advocating for these various systems: cost, buy-in, and an overall culture change. Still, while many providers have a long way to go in getting past these issues, it’s comforting to know the systems are in place to create beautiful “music.”



Great analogy, Gabe. In some respects, all types of collaborations require great effort, but ACO harmonization is far more dependent on active, consistent problem resolution and data sharing than most collaborations.

Thanks for the reply Charlene. Very true, all effective collaborations, especially in health IT, require "harmony" from all sides. ACOs symbolize that need more than anything else - most of them would go nowhere without the technology to bind everything together.

One way that ACOs will be able to breeze through technical passages and creative cadenzas to lend uniqueness to their music will be to use population health analytics to measure and deliver evidence-based medicine through the many predictive modeling tools in the market such as MedAI and Johns Hopkins ACG Groupers and others. We currently offer "6 variations on a theme."

Axiom Health Group has been playing this tune and others at ACO symphony halls for a few months. The right instrument and the right acoustics helps ACOs play their own music and mimic the sounds of big data similar to the way the insurers sound, perhaps with even higher fidelity and confidence in data origin.

ACOs don't even have to buy their own instruments in this symphony. They can lease the software and receive the periodic reporting (usually monthly) and the lease payments come from capitation payments or as a percentage withhold from claims for assigned capitated patients. They don't have to capitalize these expensive instruments before they actually need them and can scale on demand, and they share risk of the cost of business overhead, measure and benchmark quality and utilization, bring a new entity to the market, and demonstrate business efficiencies, which helps meet 4/5 elements that define economic integration as defined by the USDOJ. AS a result, they can contract with more leverage as a group.

For example, an ACO with 12,000 lives, the monthly cost can be as low as 30 cents per member per month on some of these tools, plus the cost of one nurse case manager per 7500 lives. If they capitalize this, it runs hundreds of thousands and then costs for staffing and space for staff. We never had these tools in the 1990s, and the price to use them keeps going down.

Maria Todd, MHA PhD
and (former) Principal Horn - Hollywood Philaharmonic
Horns Rule!