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ACO Management Depends on IT

Tom Enders, Jordan Battani and Walt Zywiak, for HealthLeaders Media, November 19, 2010

There will be wide variability in the types of accountable care organizations that are established in the near future. Some will be tightly organized around existing integrated delivery networks. Others will be based on independent physician associations without an integrated hospital. Still, others will be formed as a collaborative multi-stakeholder initiative, perhaps building from a sustainable health information exchange. There will be distinct payer relationships.

Some ACOs will be Medicare-specific, others focused on Medicaid managed care and others multi-payer. As the health benefit exchanges become established there will be an additional stimulus to the development of ACOs—some with integrated insurance functions, others operating in partnership with managed care plans. 

No matter what the particular ACO form, six key success factors will be critical for successfully delivering on the potential of accountable care. As the ACO becomes more mature, the breadth of information technology necessary also will increase so as to provide the connectivity and the decision support needed to manage the continuum of care.

 

ACO Maturity

Success Factor

Early

Developing

Mature

I. ACO Member Engagement

Episode of care
Call center support

Pre-care intervention;
Member outreach;
Social media (one to one)

Prevention;
Lifestyle consultation;
Remote monitoring;
Social media (many to many)

II. Cross Continuum Medical Management

Case management

Care coordination;
Patient centered medical home

Disease management;
Health maintenance

III. Clinical Information Exchange

Static;
Read-only access;
User request-based

Pushed (automatic);
Continuity of care documents

Real time sharing across all venues;
Patient access

IV. Quality Reporting

EHR (meaningful use stage 1)

EHR (meaningful use stages 2 & 3)

Real-time,
dashboard/desktop,
ad hoc reporting

V. Business Intelligence, Predictive Modeling and Analytics

Patient focused;
Episode/encounter focused data;
Retrospective;
Clinical and financial

Population-based;
Continuum of care data;
Predictive health analytics

Social and network data;
Behavioral analytics;
Real-time

VI. ACO Risk and Revenue Management

Cost accounting across the continuum of care;
Membership data management

Provider network management;
Global contracting;
Allocation of payment

Capitation management

Table 1 – ACO success factors and the characterization/focus of each associated with start-up, developing and mature ACO organizations. 

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