Healthcare News & Insights

The ‘path to success’ for ACOs requires data they can use

Leaders of both hospital- and physician-led ACOs know inherently that value-based care depends on analyzing the data available to them – from the many different IT systems in which their participating physicians operate – to make strategic business decisions that result in optimal patient outcomes and reduced costs. Acquiring usable, actionable data from so many different systems means not just data management, but data enrichment – data extraction, standardization, normalization and identity management. In this guest post, Mike Noshay, Chief Customer Officer for a provider of data enrichment and integration technology solutions for health care, explains what ACOs need to better manage the health of the populations they serve and demonstrate cost-savings quickly and efficiently.


The fact is ACOs are here to stay. “As of the end of the first quarter of 2017, there were 923 active public and private ACOs across the U.S., covering more than 32 million lives,” according to nonprofit policy organization The Center for Healthcare Strategies. “The increase of 2.2 million covered lives in the past year means that more than 10% of the U.S. population is now covered by an accountable care contract.”

With that many lives at stake, it’s time ACOs figure out how to make the most of the data.

ACOs take on risk

A relatively new hurdle for ACOs is the August 2018 proposal – a rule that was finalized on Dec. 21 – from the Centers for Medicare & Medicaid Services (CMS), called “Pathways to Success,” which will move Medicare Shared Savings Program (MSSP) ACOs more rapidly to downside risk. CMS recently found that “the majority of ACOs – 460 of the 561 or 82% of all ACOs in the Shared Savings Program (the program under which the vast majority of Medicare’s ACOs operate) in 2018 – are not taking on risk for increases in costs.” According to CMS, “Despite the program’s intent, the Shared Savings program has shown increases in net spending for CMS and taxpayers … Data on ACO performance to date has shown that ACOs that are not at risk for cost increases end up increasing Medicare spending in aggregate.”

The rule will essentially change contract agreements of upside-only ACOs to two years, rather than allowing six years as was previously the case, meaning that ACOs will now share in both gains and losses after two years. The rule will also cut potential shared savings in half – from 50% to 25% now – for one-sided risk ACOs during the short time in which they are permitted.

The National Association of Accountable Care Organizations (NAACOS) has spoken out against the ruling. “NAACOS is disappointed that CMS acknowledges that its proposals would limit the number of ACOs in the program, resulting in fewer providers in the leading Medicare Alternative Payment Model (APM), thus undermining bipartisan payment reforms and the broader shift to value-based care,” NAACOS wrote. “NAACOS’ greatest concerns lie with the low sharing rates proposed for ACOs choosing upside only and low-risk models, as well as the reduced amount of time provided to new ACOs in upside only models.”

A survey by NAACOS (before the rule was finalized) that questioned MSSP Track 1 ACOs, who would have to assume risk more quickly under the new ruling, revealed that “71% of ACO respondents indicated they are likely to leave the MSSP as a result of having to assume risk.”

A letter to CMS signed by NAACOS, the American College of Physicians, the American Medical Association, and others had requested “that CMS modify regulations … to allow certain ACOs to continue in the … MSSP Track 1 for a third agreement period before having to move to a two-sided model. Our recommendations reflect our unified expectation and desire to see the MSSP achieve the long-term sustainability necessary to enhance care coordination for Medicare beneficiaries, lower the growth rate of healthcare spending and improve quality in the Medicare program.”

Clean, usable data can tip the scales

The new CMS ruling represents a tipping point for ACOs, in which they will either rise to the challenge and succeed or become a failed experiment in managing population health. And the one thing that determines which way the scales will tip is access to usable data.

A single source of unstandardized data is hard enough to corral. The minute multiple sources are involved, such as is the case for ACOs, coordinating the extraction of that data so it can be normalized to a standard that’s leverageable and reportable becomes a monumental undertaking. Tellingly, a 2017 report from KLAS Research found that 86 percent of healthcare organizations surveyed hadn’t yet reached “deep interoperability” when it comes to their data.

Clean, enriched, usable data is a crucial foundation that ACOs need to engage in analytics, which leads to sound business decisions, lower healthcare costs and the delivery of high-quality care:

  • “93% of hospital and physician financial executives state they are actively seeking ways to link care with analytics and outcomes to support the consumerism of healthcare and shift to value-based payments.” – Black Book
  • “The nation needs an interoperable health system that … enables providers and communities to deliver smarter, safer, and more efficient care; and promotes innovation at all levels.” – The Office of the National Coordinator for Health Information Technology
  • “Interoperability is critical to effective use of shared information for core hospital activities such as care coordination, patient engagement, quality improvement and ensuring patient safety … Automatic integration of patient information received from outside sources into a receiving hospital or health system’s electronic health record (EHR) enables more timely and effective use for patient care.” – The American Hospital Association

Yet ACOs still have a long way to go to achieve true data integration. In a survey from independent nonprofit organization eHealth Initiative, ACO respondents said that data use and analytics helped them:

  • achieve cost savings – 68%
  • improve quality measures – 54%
  • reduce readmissions – 52%
  • deliver preventive healthcare – 52%
  • improve healthcare utilization – 50%

According to the same survey, the five top challenges to data analytics are:

  • access to outside data – 78%
  • data integration – 62%
  • change management – 55%
  • cost of new health IT – 38%
  • obtaining provider commitment to participate – 33%

Quality matters

As value-based care continues to be the elusive goal of the industry, hospitals, payors and ACOs are paying careful attention to gathering information needed to report quality measures. Yet they’ve been less concerned with the data quality inefficiencies behind that information. Organizations have become complacent with their current data submission process, and too often, something is missing. For example, payors frequently lack information tied to the clinical encounter. This missing information, as simple as a clinical diagnosis code, could have significant financial implications for payor and provider reporting needs.

For example, consider the case of breast cancer screenings. Most of the value sets associated with breast cancer screenings, such as whether the patient has had an annual wellness visit, mastectomy, home health services, a mammogram, an office visit or other care interactions, are simply not captured consistently across all facilities within any particular ACO. In fact, as illustrated in the example below, the only value that was captured consistently across all facilities was the patient’s sex. This inconsistent, fragmented information makes it nearly impossible for the ACO to use the data for accurate quality measurement and analytics.

Yet even when ACOs are aware of poor data quality issues, they may be unsure how to address the dilemma, have insufficient resources or have been told their EHR would help solve the problem.

What ACOs need is the ability to acquire, standardize and manage clinical data from siloed sources. This allows ACOs to reduce time and administrative burden to standardize data, reduce time to value and improve communication pathways with providers delivering care, which all result in ACOs being better able to manage the health of the populations they serve and demonstrate cost-savings quickly and efficiently. Data enrichment will be key to the future of ACOs, regardless of what regulatory changes are on the way.

Mike Noshay, MSE, is Chief Customer Officer at Verinovum, a provider of data enrichment and integration technology solutions that healthcare leaders need to serve their patients and communities.




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