Accountable Care Organization (ACO) analytics are used by huge healthcare networks that cater to tens of thousands of fragile or complex Medicare patients. Such organizations provide home-based primary care in multiple states, deliver consistent primary care, ancillary services, such as lab, radiology, and ultrasound diagnostics, and offer durable medical equipment. Healthcare organizations that utilize the software admit significant increases in the performance of such plans as tobacco and clinical depression screenings and follow-up strategies. Those results allow organizations to reach top national positions among ACOs and generate tens of millions in Medicare savings. What are the steps that those organizations follow to show high and sustainable outcomes each year?
If ACOs that participate in the Medicare Shared Savings Program (MSSP) achieve best practices in primary and preventative care metrics, they may become eligible for payment adjustments. The ACOs receive the quality composite score based on the benchmarks of the Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO). This score influences the reimbursement rates for the ACO members. The participants may receive adjustments as high as 4% upwards or downwards.
ACOs need analytics applications and platforms to receive the savings. Organizations should be able to analyze integrated data from multiple sources, e.g., electronic medical records (EMRs), billing systems, insurance claims information, etc., and generate insights from it to take actionable steps and improve performance and metrics.
Challenges of Data Access for Analytical Purposes
To appear among the top ACOs according to their performance, healthcare organizations should guarantee and document best practices in providing primary and preventative care procedures which is the cornerstone of successful MSSP performance. ACOs aim to achieve the Quadruple Aim which consists of enhancing people’s health, satisfying patients’ requirements, improving work life of medical staff, and reducing costs. Despite well-defined home care protocols and procedures of some healthcare networks, they still have to overcome certain obstacles on the way to those goals:
- It is difficult to coordinate monthly visits to patients with MSSP performance conditions and PQRS reporting requirements. While patient visits occur monthly, reports must also be submitted annually for preventative wellness visits and seasonally for immunization requirements.
- Organizations stumble upon insufficient best practices visibility. Electronic medical records do not reflect best practices regarding the required preventative and primary care metrics. It is difficult to determine the exact measures from the list of standard measures for preventative and primary care that should be applied to each particular patient.
- Healthcare providers spend a lot of time on manual examinations of previous interventions. Doctors have to study the patient’s health history, which is time-consuming and often hampers attention from the patient.
- There is no clear understanding among medical staff regarding how documentation influences measures. Providers lack the knowledge on how to use the documentation to comply with quality standards.
- Healthcare providers use multiple sources and lack an integrated approach to utilizing the real-time data. Therefore, they fail to improve patient outcomes and reach high percentile performance of the ACO measures, and receive a share of Medicare savings.
Features of ACO Analytics Software to Meet and Document ACO MSSP Measures
ACO analytics helps healthcare organizations access and use the data collected from multiple sources. Healthcare executives, quality leaders, practice managers, and providers should analyze that data and be able to do the following:
- Review population health measures, compare them to national standards, and find the opportunities for reducing costs, monitoring, and covering the demands of complex and high-risk patients.
- Find the necessary data to comprehend the measure, relevant documentation in the EMR and understand what steps should be taken to meet the measure.
- View patient-specific data and the provider schedule on a single dashboard to find out which certain medical measures are required for each patient.
- Make a list of necessary best practice measures for each patient to be performed during home visits and distribute them among doctors.
- Place orders and record care procedures at the point of care in the analytics platform in near real-time.
- Track and manage the practice performance of the practice managers.
Organizational Measures to Implement ACO Analytics Software
Analytics platforms and applications bring healthcare organizations better performance results. However, much organizational work is needed. Arranging the workflows is important as it influences the quality of the procedures and general outcomes.
For instance, healthcare executives, providers, healthtech experts, and project managers outline each measure to make the data inside the application accurate. They might contact the Centers for Medicare and Medicaid Services (CMS) for that purpose. The process includes the description of measures while taking into consideration the home-based environment, the definite measure denominator, as well as inclusion and exclusion criteria.
After the outline, the primary care measures of the home-based environment are transferred to the application, and iterative testing takes place. Quality testers usually check the usability for key end-users.
Additionally, healthcare providers optimize and standardize their workflows to achieve cross organizational data coherence in the EMR documentation and confirm data integration within the app.
It is also important to arrange training for practice managers and to explain the process of data access and usage of the information sheets that include the details on each measure, its frequency, and inclusion and exclusion criteria.
What Are the Benefits of Implementing ACO Analytics?
The ACO analytics platform allows healthcare networks to assist their providers in ensuring high-quality patient care and meeting the performance criteria. Organizations that have already benefited from similar solutions report the following results:
- Tens of millions of dollars saved for Medicare and high positions among other national ACOs.
- Relative improvement in the documentation of the current medications in medical records.
- Validation of the inclusion and exclusion criteria for Medicare patients in less than a year and timely delivery of the required care during planned home visits to achieve the ACO measures.
- Achieved improved performance even in 80-90th percentile for immunization, various screenings like high blood pressure or future fall risk screening, and follow-up initiatives.
- Other percent relative improvements include timely tests for diabetic patients, such as eye check-ups and hemoglobin tests.
ACO analytics assist healthcare organizations in adopting a proactive approach to evaluating measures, implementing updates as new data emerges, and identifying additional opportunities to enhance the data shared with providers.
How a Healthcare Software Development Company Can Help
Healthcare software development companies like Belitsoft, offer their expertise and assist top healthcare data analytics companies in building robust data operating systems.
Healthtech providers build integrated data platforms that can gather the data, store it, and manage. Such tools allow for deep analysis of the information from various sources, such as EMRs, clinic management systems, laboratory systems, financial systems, etc. Healthcare software development companies offer the following functionality:
- Automation of the workflows (cleansing, standardization, and normalization).
- Configuration of the scalable data warehouses.
- Customization and implementation of the analytical tools for creating dashboards, reports, and data visualizations.
- High level of data security and compliance with healthcare regulations such as HIPAA.
- Integration of machine learning and AI into analytics.
They also help build specialized analytical applications like ACO Analytics for:
- Integrating the information from multiple sources, such as EMRs, billing, and external insurance claim systems.
- Synchronizing the information about a patient and the taken measures in near real-time.
- Creating interactive dashboards and visualizations with integrated data.
- Filtering providers, medical departments, patients, and dates of visits.
- Showing general composite score performance and individual measure performance.
- Displaying percent overall measure compliance and compliance by individual measure.
- Indicating the current status of measures taken in different colors.
If you are looking for expertise in data analytics, data infrastructure, data platforms, HL7 interfaces, workflow engineering, and development within cloud (AWS, Azure, Google Cloud), hybrid, or on-premises environments, a healthcare software development company like Belitsoft also can serve these needs.
