Accountable care organizations, or similar partnerships between providers and payers, are "vehicles to alignment," according to H. Scott Sarran, MD, the CMO of government programs for HealthCare Service Corporation, an independent licensee of the Blue Cross Blue Shield Association. As ACOs and other arrangements take root, participants are learning one major lesson: The success of the ACO is intrinsically tied to data.
Dr. Sarran participated in a discussion about ACOs and shared savings agreements at the Becker's Hospital Review 6th Annual Meeting May 7 in Chicago. Moderated by Molly Gamble, editor-in-chief of Becker's Hospital Review, other panelists included Donald Lovasz, president and CEO of KentuckyOne Health Partners, Mike Kasper, CEO of DuPage (Ill.) Medical Group and Michael Simpson, the president and CEO of Caradigm.
As organizations gain experience in the model, they have not always had an easy time getting the data they need and being able to use it effectively. "It's literally a nightmare to collect, manage and scrub the data into something that's reliable," said Mr. Lovasz.
The "nightmare" stems from the "fragmentation of information systems that all of us as providers use," Mr. Lovasz said. At KentuckyOne Health Partners, getting information and data sometimes requires picking up the phone and calling a payer organization, instead of it being sent in a timely matter.
In addition to trouble accessing data, ACOs can also run into issues in interpreting data or even using the right data. Mr. Kasper said that organizations need to refine the data points they look at in order to drive results. For example, DuPage Medical Group started looking at specific data points like length of stay and blood transfusion rates and working with physicians to drive change. "Every single [point] actually improved in a statistically significant way in less than a year," Mr. Kasper said. "If you stay at the big data level, you won't produce these kinds of results."
Mr. Simpson also stressed the importance of getting data to the right people who can drive change. "Look at the data, but drive it back to the point of care where clinicians can take action and make a difference," he said.
Additionally, Mr. Simpson noted that data for ACOs needs to come from multiple sources. "Data shows us the truth but can mislead us," he said. Instead of looking at data from just one source, like an EMR, organizations in accountable care arrangements need to look at all sources. "It's critical that you bring in expertise from providers, claims, EMRs, the entire gambit," he said. "If you just look at EMR data you will not succeed."