5 Key Steps for Accountable Care Organizations
ACOs seeking to optimize clinical, operational, and financial performance need a data strategy to maximize the usefulness of all available data. Providers generally have a decent handle on the data contained in their EMR and many use that data effectively, in conjunction with care management and financial dashboards often provided by the EMR or through other solution providers. But claims data serves an essential function in supplementing the clinical data, especially in areas where members seek out-of-network care and where population health management requires a more complete picture of all services provided to members being managed.
A data strategy requires a clear definition of all available data, as well as an approach to use that data analytically, in a way that generates insights that drive operational improvements. A robust analytic approach, when applied to a complete, validated, and edited dataset, will allow providers to identify opportunities for improvement across multiple operational areas that are critical for value-based care (VBC). Integrating claims data into these datasets will allow for analyses related to:
- Gaps in Care
- HEDIS Measures
- Network Analysis & Provider Performance
- Cost & Utilization Tracking
- Population Health Management
- Value-Based Contracting
Here are 5 key steps we recommend to tap into the full value of claims data.
Step #1: Develop a data strategy
Healthcare organizations need a strategy for all data types, including claims, Rx, eligibility, lab, biometric, wellness, medical management, practice management, and EMR data. Commit to developing a data strategy that ensures your data is clean and standardized before you ever even build a dashboard—saving your organization from the inaccuracies and manual mess that can slow down or obscure effective analysis.
Step #2: Develop an approach to acquire, integrate, and distribute all the data
Without well-tested processes to manage the flow of incoming data files, health systems can quickly end up with operational delays and data analysis errors—a risk that multiplies the more payers the organization is contracted with.
Establish a system to identify received files, late files, missing files, and duplicate files. You will additionally need a system to reconcile and validate the content of the files, the population included, and the dates of the services to make sure what’s there reflects reality. It’s also critical to ensure the data is consistent with previous files ingested from the payer.
Finally, make sure that you have a robust data model that can handle all the types of data that you want to integrate, and can produce standardized data that conforms to your data warehouse requirements.
Step #3: Develop analytical approaches with tools that make sense for your team
Once you have acquired and integrated your data, you need to analyze it effectively. Start by defining all of your goals for the data—i.e. whether you’re looking for clinical insights, financial insights, or point-of-care solutions—and then determine what tools will best surface the relevant data. Depending on your goals, some analytics teams will be best served by an off-the-shelf tool like Tableau, others may want a purpose-built analytic tool, and others may send the data out to other analytics vendors. Then, take advantage of your cleaner, standardized, analytically-ready datasets by integrating these insights into HEDIS reporting, cost and utilization tracking, downside risk management, and other key areas of VBC.
Step #4: Develop an approach to integrate the analytic insights into your operations
Now that you have actionable insights based on complete and accurate datasets, it’s time to actually take action. Develop a plan for how to address the performance indicators in your dashboards. For example, if your costs-per-physician metrics show that some doctors are providing more costly care—without the increase in quality to back it up—then you need a plan for who will present the data to your doctors, what guidance to provide the doctors, and at what intervals you will measure progress.
Step #5: Develop an approach to monitor your strategy’s effectiveness
Last, make sure you understand whether your data strategy is working. Ask the following key questions:
- Does your C-suite trust the dashboards and Key Performance Indicators that you share with them?
- Can you make operational decisions based on your datasets?
- Are your Key Performance Indicators moving in the right direction? (i.e. are costs decreasing, is network leakage decreasing, etc)
- Is your team spending more time analyzing the data than prepping it? (If not, you may want to consider a more efficient approach to acquiring and integrating your data.)
HDI handles the tracking, management, transformation, and distribution of data so that your team can make the best use possible of the rich world of healthcare data. Contact us to learn more.
