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Business Intelligence for ACOs: Where’s the Urgency?

February 23, 2015
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ACO compliance needs business intelligence. But where's the urgency from most providers for implementing BI solutions?

In this age of accountable care, there are increasing demands for data for reporting and reimbursement purposes.  Since healthcare providers are often structured around clinical departments, much of the data pertinent to accountable care may be managed/stored within departmental systems. 

This is giving rise to data mining and data warehousing as a means for capturing relevant data.  Maybe it is other priorities, but am I wrong in that there doesn’t seem to be much urgency for building such business intelligence (BI) capability in healthcare organizations?

In the words of the Center for Medicare and Medicaid Services, “Quality data reporting and collection support quality measurement, an important part of the Shared Savings Program. Before an ACO can share in any savings generated, it must demonstrate that it met the quality performance standard for that year.  There are … interactions between ACO quality reporting and other CMS initiatives, particularly the Physician Quality Reporting System (PQRS) and meaningful use. [There are] 33 quality measures, which span four quality domains: Patient / Caregiver Experience, Care Coordination / Patient Safety, Preventive Health, and At-Risk Population. Of the 33 measures, 7 measures of patient / caregiver experience are collected via the CAHPS survey, 3 are calculated via claims, 1 is calculated from Medicare and Medicaid Electronic Health Record (EHR) Incentive Program data, and 22 are collected via the ACO Group Practice Reporting Option (GPRO) Web Interface.” (

In the case of cardiology, there are several well-established registries such as the National Cardiovascular Data Registry (NCDR) that require data mining and reporting.  To aid this process, there are several well-established vendors such as Cedaron and Lumedx that automate the collection and reporting process. 

To meet the demands in an accountable care environment, there will need to be similar provider and vendor initiatives to find creative ways to mine and manage reporting requirements.  This will be further complicated by the number of different initiatives and agencies that will require reporting.  As Leslie Falk indicates in a posting on ACO reporting, “…[a] growing number of reporting requirements – to name just a few – Meaningful use, Accountable Care Organization (ACO), Physician Quality Reporting System (PQRS), TCJ (The Joint Commission), Centers for Medicare and Medicaid Services (CMS) Core Measures, Financial and Operational KPIs, etc.” (

This is where data mining and warehousing come in.  These tools will help with acquiring the necessary data, but not necessarily with reporting the data.  Extracting data into a data warehouse will require the use of industry standards for communication with the disparate departmental systems.  There will also need to be reporting applications to improve the efficiency of reporting to government agencies.  But who is stepping up to the plate to address these needs? 

My question to the industry is where is the urgency in meeting these requirements?  Are there specific time frames that must be met?  Is there a cost/benefit ratio to investing in data mining and reporting applications, over manual methods of data collection and reporting?  It seems to me that there has been a major investment in Electronic Medical Records (EMR) that provide the electronic means for acquiring the data.  What may be missing is the intelligence to aggregate the necessary data into the format for reporting purposes. 

I would welcome reader’s response, particularly those that are actively investing in the technology.  Is there a priority to such an investment?  What are the driving forces that will accelerate development and investment?  What are the impediments to investment, and why is it not a priority for others?  I welcome all your input!