Advanced data warehousing and analytics: ACOs must be able to integrate and analyze multiple data sources, including payer derived claims data (providing data on care rendered both inside and outside the ACO) as well as administrative data (scheduling, billing), and clinical (both structured and unstructured). This requires an ACO to invest in data warehousing technologies and analytical tools in order to take full advantage of the available information and provide guidance to providers and managers. We continue to build this set of solutions.
Next generation care delivery and coordination tools: The ACO must have new ways to connect various members of the patient care team including patient to provider, and provider to provider. These technologies include but are not limited to asynchronous and synchronous virtual visit capabilities, referral management software and high risk care management software, and remote monitoring for carefully selected patients. We are currently employing all of these types of health information technology.
Innovative clinical performance management tools: Third, the accountable care organization should have clinical performance management technologies that allow its providers to reduce care gaps and improve stewardship of resources. This includes, for example, advanced clinical decision support for radiology ordering and procedures and patient registries with clinical workflow integration.
In general, we have found a majority of accountable care information technology vendors are repurposing their existing assets for new applications towards population health management. For example, warehousing companies with strengths in the financial industry may convert their product for the health care market, or a company built for patient outreach and appointment reminders may convert their product into population health clinical registries. Given the relatively new nature of risk-based contracting, and uncertainty of the future of this payment model, it makes good sense from a vendor perspective to first try to repurpose existing assets, instead of creating built-for-purpose technologies that are more costly, and may not get to market fast enough to meet customer needs. The challenge for providers is that many of these repurposed technologies do not quite solve the particular challenges the provider is attempting to address. Accountable care organizations therefore are faced with challenging decisions regarding the purchase of a less than optimal product, waiting for the product segment to mature, or building the solution themselves.
Conclusion
We have described an approach to ACO success that includes the creation of a sustainable financing mechanism, new incentive structures, a high-risk care management program, integrated mental health services, tools for specialist engagement, a post-acute strategy, fostering patient engagement, and new clinical and analytic technologies. The breadth and depth of these changes to care delivery present numerous daunting challenges. Our experience suggests that partial approaches, implementing just a subset of the approaches listed above, will not constrain cost growth because costs are just shifted to a different part of the care delivery system. We conclude from this experience that a comprehensive approach undertaken within a system that is capable of integrating care across the full continuum of care delivery has the best chance for successfully managing costs and improving care. Nonetheless, the challenges associated with change on this scale are legion. Key challenges facing the committed ACOs include: educating their boards and management about requirements for success as an ACO; advocacy for state and federal regulations that support the success of ACOs; and engaging patients as active participants in the changes. Importantly, financial returns (as shared savings) on the investment required for these changes will not be available within short-term contract cycles, so committed organizations will need to plan for the long haul.