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Posts Tagged ‘ACO’

10 Healthcare Analytics Trends for 2016: Trend #8



Accountable Care Organizations (ACO) spend a good amount of time discussing which technology systems to use, but very little time on determining who owns the data. ACOs have multiple stakeholders including partners in the ACO, patients, and insurers. Each of these stakeholders have a vested interest in the vast amounts of data within the ACO, but many times the question of who owns the data goes unanswered.

According to Definitive Healthcare, there are more than 800 ACOs representing more than 200 health plans, 3,900 providers, and 300,000 physicians. And these ACOs use more than 125 different technology vendors, making it a very complex environment.

There are many different opinions on the topic of data ownership. Some will say patients own their own data; others believe providers own the data on their systems, and insurance companies own the data on their systems. Each of these scenarios provides challenges for ACOs, making it critical for them to have a strategy in place to tackle the issues of data ownership.

In today’s healthcare landscape, all stakeholders need to be true stewards of patient data, and they should act in the best interest of the patient. If patients are expected to be more accountable for their care then they need access to their own health information. If an ACO, health plan or healthcare provider is going to be more accountable for patient outcomes, then they need to have access to the data. Read the rest of this post »

Tackling ACO Data Challenges

How do we engage patients, coordinate care, improve quality, lower costs and share savings all at Tackling ACO Data Challengesonce? A group of Accountable Care Organizations (ACOs) will be in Baltimore this week discussing this and other topics on establishing and sustaining ACOs.

One of the challenges of forming and sustaining ACOs is establishing shared goals and shared knowledge. I was involved in the airline industry earlier in my career and was part of the team who automated the On-time Departure and other performance metric bonuses at then Continental Airlines. Prior to this, I had dabbled in Change Management and Quality Assurance topics but this was my first real experience with “what you measure is what you improve” or “pay for performance”.

The ACO challenge is similar to the challenges of Performance Management within the diverse units of a hospital but it is complicated by the many different types of organizations (and communication languages) that may be partnering. I’m really looking forward to learning more about ACOs and how we can apply clinical analytics to costing solutions to measure and report shared savings.

Stay tuned for updates!

Follow me on twitter @teriemc

2015 Healthcare ACO Trends and The Key to Success [Infographic]

Accountable Care Organizations (ACOs) as a model to deliver high-quality, cost-effective care across the continuum and improve population health management (PHM) has significantly increased. In an ACO, healthcare providers take responsibility for the health of a defined population, coordinate care across the continuum, and are held to benchmark levels of quality and cost. In 2015 ACOs will continue to be on the rise! Read the rest of this post »

The “Yellow Brick Road” to Value-Based Care

“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?The “Yellow Brick Road” to Value Based Care

Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.

As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician.   This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?! Read the rest of this post »

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Improving Patient Experience – Not Just for Inpatient Settings

Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like. 

With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience.  However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting.  Therefore, it is equally, if not more important for those  in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model. 

patient engagementPositive Outcomes and Opportunities

The benefits to improving patient experience are plentiful, regardless of the care setting.  However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities.  Here are the exact details they provide:

  1. Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
  2. Patient retention, loyalty, and growth – By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients.  As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy. Read the rest of this post »

What will it take to decrease nursing home readmissions? #HIMSS14

HIE, clinical data, quality measures, financial and claims data along with healthcare analytics – what does it take to decrease readmission rates in nursing homes?

There is so much attention these days on making the most of all of the clinical and financial data regarding healthcare, hospital readmission costs and reimbursement, but do we really know what changes can or will make a difference?

It has been a long time since I have done bedside nursing, but I can remember how often I would have one or more patients assigned to me who had come from a skilled nursing facility, long-term care facility or “nursing home.”

home_care_nursingThe American Health Care Association (AHCA), the largest association representing skilled nursing care centers in the country, reports that every year, nearly 2 million Medicare beneficiaries are readmitted to the hospital within 30 days of being discharged, at a cost of $17.5 billion. Of readmissions, one fourth are skilled nursing care patients, receiving post-acute care (recuperative or rehabilitative services).

According to the recent Office of Inspector General (OIG), Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring report, in Fiscal Year 2011, one quarter (24.8%) of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions, at a cost of $14.3 billion for the hospitalizations. The hospitalizations were required for a wide range of conditions with septicemia the most common. While the majority (67.8%) were transferred to hospitals only once, 20% transferred two times, 7.2% transferred three times, and the remaining 5% transferred four or more times. Of the Medicare costs for hospitalizations in FY2011, care for a nursing home resident cost an average of $11,255 per hospitalization, which is 33.2% higher than the average Medicare hospitalization ($8,447). Read the rest of this post »

Reframing the ACO Analytics Problem with Malcolm Gladwell

I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).

Malcolm Gladwell quoteWhile I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely.  One of the key learning points for me from these sessions was this:  “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.

How do we “reframe the problem” when it comes to ACO reporting and analytics?  There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics?  Do we “build vs. buy”?  Depending upon the organizational size, legacy systems and IT support, the decision can be difficult.  What is good for one system may not work in another.  So where do we start?

A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step.  Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics.  Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”

Read the rest of this post »

Healthcare Analytics for the Patient Centered Medical Home

The patient centered medical home (PCMH) emphasizes care coordination and communication between various healthcare delivery systems. This coordinated care system can lead to better quality healthcare delivery as well as a better patient experience – but in order to achieve these benefits, providers must be able to see and interpret data from across the many entities the patient interacts with.

Leveraging clinical data from EMRs, HIEs and patient devices allows organizations to:

  • Enhance access and continuity
  • Identify and manage patient populations
  • Plan and manage care
  • Provide self-care support and resources
  • Track and coordinate care
  • Measure and improve performance

Join us October 29th for the webinar “Make the Most of Your ACO with Healthcare Analytics.”  You will learn how Oracle Enterprise Health Analytics (EHA), coupled with Oracle Business Intelligence and Oracle WebCenter, fulfills the ACO mandate for a patient centered medical home.

Click here to register for the webinar.

Top Technology Trends in Healthcare – July 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Accountable Care Organizations: First Year Results

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. First year results for ACOs were recently released, with very mixed success and several hospitals dropping out of the program.

The Quantified Self

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

Read the rest of this post »

Top Technology Trends in Healthcare – June 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

ACOs and Patient Centered Medical Homes

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. Patient Centered Medical Homes (PCMH) focus on improving the quality of care delivered by creating a health care environment that facilitates communication between the patient and their physician, allowing patients to receive and understand the care they need when they need it.

Telehealth and Remote Patient Monitoring

The healthcare industry is experiencing revolutionary changes stemming from the rapidly shifting role of the patient within the continuum of care. This is resulting in high demand for easier access to healthcare professionals, access to online medical information, and alternatives to traditional care. Telehealth allows for the transmission of medical images, video, audio and information related to diagnosis and treatment can be stored and sent from the provider’s computer or mobile device via secure data exchanges. Remote Patient Monitoring allows patient’s health data to be sent electronically to a provider who then can analyze it and respond with appropriate recommendations.

Read the rest of this post »

One big way that Big Data will drive population health management

I’ve been working directly with our partner, IBM, lately, on our own healthcare analytics offerings. Recently, I saw this quote in a presentation slide on one of our projects:

“Delivering integrated care requires an ability to transform data into actionable insights.”

These insights lead to smarter decisions, and that ultimately leads to better outcomes for patients.

For an organization to be successful as an Accountable Care Organization (ACO), it must be defining and leading communities of care by going beyond just information share, and toward co-creating the next generation healthcare industry.


I think Premier healthcare alliance is working toward making this next generation healthcare industry a reality.

And here’s why.

InformationWeek published a story yesterday on big data and analytics in healthcare. In the story, they highlight a new collaborative of healthcare organizations that was created by Premier health alliance. Called the Data Alliance Collaborative (DAC), it enables these organizations to learn from one another as they develop population health management tools.

IBM hardware and software aggregates member data while Premier, working with IBM and with our healthcare team, developed an integrated payer and provider data model on which DAC members are building these population health management applications.

Imagine this:

Clinical, financial and claims data, from multiple care systems, coming together in one place to produce insights and trigger alerts and reports that allow providers to improve care for individuals.

The DAC is working on building tools that will:

  • Quickly notify providers about patients who haven’t filled a prescription within 24 hours. This should help them to improve transitions of care.
  • Analyze electronic health records and administrative data to find patients more likely to be readmitted before they’re discharged. This will take into account risk factors that often lead to readmissions using an evidence-based checklist by medical condition. They call this an “all-cause predictive readmissions model.”

Really neat stuff!

Keith J. Figlioli, senior VP of healthcare informatics for Premier, is quoted as saying,

“One leading system integrator is creating assets for this group that will later be commercialized if somebody consumes them.” That integrator is Perficient.

We are so proud to be a part of this, and we look forward to talking more about what these tools look like and how they’re improving care and working to improve population health management for healthcare organizations across the country!

Learn more about how Perficient and Premier will Deliver Transformative Healthcare Analytics to Improve Patient Care.

Read the full story by InformationWeek here: Healthcare Collaborative, IBM Partner On Big Data Platform

Will ACOs drive up costs for patients?

I was recently talking with one of my colleagues about a strange situation that happened to her when her local hospital and healthcare provider merged with a larger healthcare system.  As a result of the merger, she no longer had a local healthcare provider in her town that took her insurance plan. In essence, she was a victim of healthcare merger mania and had to find a new healthcare insurance plan for coverage.  Healthcare organization mergers are part of a broad national trend that is driven by accountable care and the tremendous pressure to cut costs, improve productivity and improve outcomes.

As a result of this merger trend, medical care is being concentrated in fewer institutions, and concern about the impact on higher prices is increasing.  A hospital merger boom in the 1990s increased patient costs by 5 to 40 percent in areas where only a few hospitals dominate, according to the Robert Wood Johnson Foundation.  Large healthcare organizations with multiple hospitals tend to charge higher prices in communities where they outnumber their rivals, says health economist James C. Robinson of the University of California, Berkeley.  This information contradicts the usual arguments for accountable care that merging or affiliating with generate greater efficiencies, higher quality of care and increased savings.  More than 100 hospital merger deals took place in 2012, double the number of only three years earlier.  Here is the scary statistic: Of the 5,724 hospitals in the United States, about 1,000 will have new owners in the next seven years or so, according to Gary Ahlquist, a senior partner with the consulting firm Booz & Company.

Read the rest of this post »