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ACO Management Depends on IT

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

Business intelligence, predictive modeling and analytics
Placing information about individuals in the context of the larger assigned population allows information management and analytical processes to account for the larger scope of ACO obligations to provide high-quality care at acceptable cost, as well as to ensure favorable clinical and financial outcomes for the assigned population. Creating a complete data set for the ACO population will require integration and rationalization from multiple sources and systems including:

  • Patient level data within the ACO: clinical transactions from EHRs, lab and imaging, and information from pharmacies and physician practice management systems
  • Patient level data from outside the ACO: clinical transactions from out of network providers supplemented with claims data from health plans and pharmacy benefit managers
  • Member level data from non-traditional sources: health risk assessments and self-care and wellness regimens

Applying business intelligence and predictive analytics to the data set will inform improvements in patient care processes and activities across the continuum of care and to risk and financial management activities as well. 

Applying predictive clinical analytics allows the ACO to monitor care patterns, to assess adherence to protocols and best practices, and to anticipate future needs and patient requirements. This effectively creates the continuous feedback loop required for ongoing process improvement. Similar predictions can be made based on analysis of financial information and risk patterns to inform risk management activities and financial management activities as well.

This ability will be especially important in the negotiation and management of payer contracts, where the ACO bears financial risk for clinical outcomes, and will require finely-tuned abilities to predict acuity, utilization and the cost associated with the responsibility for the care of the defined population.

  ACO Risk and revenue cycle management
Managing the risk and financial responsibilities of an ACO will require a fundamental reorientation of traditional revenue cycle activities. As the focus of financial and administrative processes changes to include the entire assigned population, ACOs will require an information system that allows them to recognize and capture information before, during and after the period when individuals become patients—in effect, managing beneficiaries rather than patients. Health plans use membership repositories and membership management systems for this function and ACOs will need to quickly adopt similar systems and processes to ensure that they can properly identify, monitor and report on all the activity associated with their population. 

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