In the two years since CMS’ Shared Savings Program launched the creation of Medicare accountable care organizations (ACOs), a growing number of physicians are participating in such groups.
Still, the ideas of entering a risk-based partnership and sharing savings can be daunting concepts. There are challenges, too, such as tracking patient outcomes, understanding the costs and quality of providers in and out of your network, and more intensely managing care for the sickest patients.
Thus, data-analytics technology that helps ACOs look at outcomes and costs and, in turn, save money, is gaining traction.
One of the new notables in this category is athenahealth’s athenaClarity, a cloud-based service that helps healthcare organizations manage their network of physicians and populations of patients, targets healthcare organizations in succeeding under new payment models such as these.
“It’s become apparent that in order for practices to thrive, they need to be integrated with other practices,” Todd Rothenhaus, CMIO, athenahealth, told Physicians Practice at the recent HIMSS 13 show in New Orleans. “And payers are saying, ‘if you want more money, it has to come with more savings and better outcomes.’ If primary-care doctors had complete clarity into what their patients were doing, they would better manage care.”
The data service does a lot of things, most notably, collecting data across the continuum of care, and presenting information at the point of care so the practice knows what patients in a risk-based, shared-savings pool are doing, and how that correlates with outcomes and costs.
For example, if 10 percent of a practice’s Medicare patients are part of an ACO the practice is a member of, athenaClarity can pinpoint those patients who are seeking care outside of the ACO (such as blood work or surgery). Then, the practice can take actions to try to ensure that care is appropriate and cost effective.
“The first thing the organization can then ask is, ‘how do we make sure our patients are getting the highest-quality, most cost-effective services?’” said Rothenhaus. “It’s going to show you inpatient/outpatient, home care, and nursing home activities … 100 percent of medical expenditure of a certain patient population. Once you have an understanding of where the costs are going, you can see whether you’re managing patients through the ecosystem best.”
Another vendor in this emerging market, eClinicalWorks, is also eyeballing the physician-led ACOs market and Patient-Centered Medical Homes with its offering, eClinicalWorks Care Coordination Medical Record, which it unveiled in October.
“The trend we are seeing, at least as you look at organizations that are forming ACOs, the recent wave of signings are of physician-led ACOs, rather than hospital-led ACOs,” Girish Kumar Navani, CEO and co-founder of eClinicalWorks, told Physicians Practice. “Physicians are asking hospitals to participate but not be the nucleus of the ACO. We see a lot of physicians banding together and forming an ACO and saying ‘hey, we don’t necessarily need the hospital.’”
The web-based product combines the data analytics function with care-planning and care-management applications. Functions are designed help healthcare organizations build high-performance care teams and drive patient engagement. There are also features to integrate actionable reporting into population health management and quality-improvement work flows.
But while the analytics component might be the most interesting physicians in the current industry push for “big data,” it’s not the only component of importance to a shared-risk partnership.
“What we’re seeing in the market is an extreme focus on analytics,” said Navani. “But analytics alone without a rule engine is not going to solve the problem.”