Integrating IT systems and aggregating data across multiple organizations will lead to higher quality, more effective and more efficient patient care. The components an ACO required to accomplish these goals include an electronic health record (EHR), a health information exchange (HIE), data management resources, a clinical analytics solution and patient registries.
An EHR system that captures necessary patient data, supports care-related transactions and provides clinical decisions to support the use of the evidence-based protocols is critical.
Real-time data sharing through an HIE solution will promote clinical integration and support the goals of the ACO. The HIE enables the electronic distribution of all types of information—including laboratory, radiology, prescriptions, orders, hospital discharge summaries, continuity-of-care documents and transcribed reports—to all physicians and payers within the exchange. The use of an HIE allows physicians, payers, hospitals and care managers to proactively engage with each other to manage care and costs.
Real-time sharing requires more than just setting up pipelines for data transfer. There needs to be a shared data warehouse, whether physical or virtual, with meaningful, compatible clinical information and claims data for standardized reporting across the organization. Sitting on top of the data warehouse is an analytics solution that supports predictive modeling, quality measurements, gaps-in-care analysis, evidence-based medicine and financial performance. With compatible data, augmented with analytics and predictive modeling, value-based partnerships can measure progress against their clinical, financial and utilization goals—and ensure population health management, clinical integration and care improvement.
As part of the integrated data solution, the ACO should utilize common patient registries to identify patients at risk for poor health outcomes based on specific risk factors. These registries allow clinicians and other care managers to proactively address these concerns to minimize disease progression and maximize health outcomes by precisely targeting interventions for patients who will benefit most.
This post is the last of an 11-part series that proposes structures and actions that characterize successful accountable care organizations. Click here to download A Model for Value-Based Provider/Payer Partnerships white paper that covers the subject more in-depth.
- A Model for Value-Based Provider/Payer Partnerships–White Paper
- Trailblazers in Accountable Care–White Paper
More from this series:
- Care management for high risk patients
- Improving overall population health starts at better care for individuals
- Empowering patients to support population health initiatives
- Care integration requires re-thinking care delivery processes–Part 2
- Care integration requires re-thinking care delivery processes–Part 1
- Benchmarking clinical, financial goals key for ACO performance and care delivery
- ACO governance and organization models must build in accountability for providing integrated, high quality care—at a lower cost
- ACO Governance: Align Functions of the Operations Team to a Common Goal
- Engaging Physicians in ACO Development and Operations
- Upside and Downside Risk Should Be Part and Parcel of ACO Financial Arrangements
—Cynthia Kilroy, Sr. Vice President, Provider Strategic Initiatives, Optum