CMS releases Sunshine Act guidelines

http://m.healthcarepayernews.com/content/cms-releases-overdue-sunshine-act-guidance

ACO Fact Sheet

National Committee for Quality Assurance (NCQA) recently published a fact sheet on Accountable Care Organizations. Read the Fact sheet here (http://www.ncqa.org/tabid/1312/Default.aspx). This gives you a good overview of why you should consider becoming an ACO.

More Regulation - ACO!

If you are like me, you are probably jumping up and down in joy that there is more regulation afoot (not!). ACO (accountable care organization) regulations came out last week. You can read all 696 pages and sift through the data or I can try to provide you a snapshot. Here you go:


Measurements
Quality measurements reduced from 65 to 33! Well, that is reduced in half. Got to be a good thing. Yes, it is a good thing. The measures are now categorized into 4 domains, namely:
- Patient/Care Giver experience (7 measures)
- Care Coordination/Patient Safety (6 measures)
- Preventive Health (8 measures)
- At Risk Population (12 measures: 7 measures, including 5 component diabetes composite measure and 2 component CAD composite measures)


Pretty Simple, eh? Each domain is given a weightage percent of 25% each and then reported for each of these measures.) In the next blog, we will take a deeper dive into the measurements. And if you want to go straight into implementation, see how Meta Analytix can help you here: http://www.metaanalytix.com/page.php?page=36



Who is eligible?

The newly added section 1899 of the Social Security Act or SSA provides examples of groups of service providers and suppliers that may form an ACO, including 

(i) physicians and other health care practitioners (ACO professionals) in a group practice, 

(ii) a network of individual practices, 

(iii) a partnership or joint venture arrangement between hospitals and ACO professionals, and 

(iv) a hospital employing ACO professionals. ACOs eligible to participate in the MSSP (Medicare Shared Savings Program) will manage and coordinate care for their assigned Medicare fee-for-service beneficiaries.

What are the requirements?
According to the IRS (IRS?? - http://www.irs.gov/pub/irs-drop/n-11-20.pdf), the type of organizations wishing to become ACOs must meet the following criteria.



1) The ACO shall be willing to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.


(2) The ACO shall enter into an agreement with the HHS Secretary to participate in the program for not less than a 3-year period (the MSSP( (Medicare Shared Savings Program) agreement period).


(3) The ACO shall have a formal legal structure that would allow the organization to receive and distribute payments for shared savings under § 1899(d)(2) to participating providers of services and suppliers.


(4) The ACO shall include primary care ACO professionals that are sufficient for the number of Medicare fee-for-service beneficiaries assigned to the ACO under § 1899(c). At a minimum, the ACO shall have at least 5,000 such beneficiaries assigned to it under § 1899(c) in order to be eligible to participate in the MSSP.


(5) The ACO shall provide the HHS Secretary with such information regarding ACO professionals participating in the ACO as the Secretary determines necessary to support the assignment of Medicare fee-for-service beneficiaries to an ACO, the implementation of quality and the other reporting requirements under § 1899(b)(3), and the determination of payments for shared savings under § 1899(d)(2).


(6) The ACO shall have in place a leadership and management structure that includes clinical and administrative systems.


(7) The ACO shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.


(8) The ACO shall demonstrate to the HHS Secretary that it meets patient-centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans.


That's about it. If you have questions, feel free to call me. If I am on the golf course, I am not answering my phone!

Micro Informatics

Recently, we launched our FREE, yes FREE, iPhone app to help providers keep track of OR Utilization. (To appease our sales and marketing folks, here is more information about the app: http://www.metaanalytix.com/page.php?page=35). It only does one thing, that is, keep track of OR Utilization. You ask me, when you have the Cadillac of informatics solutions, why launch a "micro informatics" app? One very simple reason. Delivery of information at the point of decision making. The reason why we built the app is because a couple of friends of ours, who work at surgical departments said, we are always asked how we measure in relation to our goals. We have no way of knowing it till the end of the month, nor do we have an effective way of tracking where we are or justify a lower score than what is expected of us. So, here are some reasons for "micro informatics":

* It is a great motivational tool. If you can keep track of where you are, you can change directions accordingly to achieve more.

* Educational purposes: Research is usually done at a macro level. But if you can use the results of that research and deliver it at a micro level, you can deliver the latest information at the point of care. For example, an ER doc running from patient to patient, maybe able to quickly access the latest findings in research at the point of care.

* It is a great data collection mechanism. You get better data from the "horse's mouth", so to speak. Better data, better analysis.

Skim on it now, you'll pay later

Everybody wants to cut costs. "Bad economy, can't commit enough money right now...", we have heard it all. The thought process is, let's do the one thing I need right now (at dirt cheap prices), and then we'll go from there. Well, it would be a sound financial decision.... if you are buying groceries! If you are planning an informatics initiative, however, it is a bad idea. Now, solutions like ours, are designed specifically with that kind of need in mind and can scale to need. But most are not. So if you are investing in an informatics solution, invest in it. It doesn't go bad after a week. In fact, in the long run, it will help you cut costs and save money. It really is not like buying a car where, as soon as you drive off the lot, the value drops by 10%. Over time, the more data you have, the better your analysis is going to be. It is an investment. It may not be a revenue "generator", but it certainly is an "expense reducer", if used properly. Some food for thought.

Feedback Requested

As I was talking to a very smart friend of mine who is in PR & Communications, she asked me what my company did. As any good technologist would do, I told her that we are a health informatics company and that we have an end to end informatics platform that extracts data from disparate systems and presents reliable information to key stakeholders in Healthcare for better decision making. She asked me again, "what do you do?" and explained to me the importance of simplifying our message. So here is an attempt. Your feedback will be greatly appreciated. Especially if you are in healthcare

Which one of the following sentences resonates with you about what we do?

1. Helping improve quality of care and reduce healthcare costs through reliable information.

2. Providing business and clinical intelligence to decision makers in healthcare.

3. Providing cloud based analytics and data warehousing for healthcare.

4. An end to end informatics platform for healthcare at a fraction of the cost.

5. None of the above, I still don't know what you do.

Informatics for IPAs

Some of the IPA customers we talk to, all say the same thing. "I don't have the data to defend my contract negotiations". So how can an IPA integrate data to better negotiate terms in a "shrinking profits" landscape?

Step 1: Remember step 1? METRIC? (Measure Everything That Really Impacts Customers"? Yes, step 1 hasn't changed. Not one bit. In this particular case, since your negotiations are probably based on HEDIS and PQRI measures, that's the first thing you want to list out. Which of those measures will help you show your quality of care and performance.

Step 2. Collect Data. If you are like most IPAs, you have 5 or more EMRs to deal with that are being used within the physician practices. Most EMRs, save a few, have ODBC compliant databases. Solutions like ours can pull data directly from those systems. And for the others, you can integrate data using the more traditional, "flat file" approach. This is more technical than anything else.

Step 3: Define your reports. What reports will help you better negotiate rates? If you find anomalies with regards to physician performance, how can you get that one practice up to speed with everyone else so that you can negotiate better? How often do you need these reports? Define these and the next time you walk into contract negotiations and the payer tells you that your Physician performance is "this" based on claims data, you can confidently say, "no, our data shows a different picture".

So negotiate away, you IPA samurais, and bring up that profitability level!

Wonder Why BI implementations fail?

Take a look!

http://www.youtube.com/watch?v=78FJBDKSYPY

ACO Series, Part I

So, people have been (I hate saying "people", it's like saying "they say...". My first question is, "Who are the famed "they"? In this case, who are these "people"? But for the purposes of this post, I can't take names, so "people" ) have been asking me about ACOs and the role of analytics in it. I read a recent study done by American Hospital Association and McManis consulting titled "Activities and Costs to Develop an Accountable Care Organization". If you haven't read it, it is a good read. In the report, they break it down into four major categories:

1. Network Development and Management

2. Care Coordination, Quality Improvement & Utilization Management

3. Clinical Information Systems and, my favorite

4. Data Analytics.

Now, it is interesting that they broke out Data Analytics as a separate entity. In my humble opinion, Data Analytics has implications in all three of the other areas. For example, the stated definition of ACOs is: "intended to manage the health of a defined population and to be held accountable and reimbursed based on measurable improvements in quality and patient satisfaction, plus reductions in costs". Sound familiar? If you have been reading my blogs for the last two years, you would have heard these two terms repeatedly:

1. Improving Quality of Care

2. Reducing cost of care

And why do I think Analytics has implications in all three? Well, let's put it this way. You don't throw money at something and hope that it sticks do you? If you answered yes, well...you are reading the wrong blog, but if you didn't, then read on.

Let's take a look at section 1 of the study, Network development and management. The study details about 9 activities that you have to do to achieve the goals of this section. I am not going to go into details of all of them. But let's examine a couple.

* Recruiting/acquiring primary care professionals, right-sizing practices

Great goal. But how do you achieve this? Do you want to acquire every PCP that is associated with you? Probably not. You want to acquire the "best" ones. You criteria for defining the "best" might differ from your neighbor's, but you still want to acquire the best and drop off the dead weight. (Remember the fact that you are trying to "reduce costs" through this activity). So how do you know who is your best target for acquisition? Historical data of course! So, define the metrics which allow you to define your "best case scenario", run those metrics against your historical data and see who pops up at the top! You might be surprised. If I were a betting man, I would bet a dollar on it!

* Compensating physician leaders

Uh oh! Yes, I went there. This is a touchy subject. Well, the question is, how do you define a "leader"? Is it the physician who can do 40 surgeries, play 18 holes of golf, take the kids to soccer practice and have dinner with the family all in a day? Could be. It could also be the physician who has the least infection rates. It could also be the physician with a 100% patient satisfaction rate. So now we have a combination of metrics (weighted, of course to come up with the definition of a "leader"). Again, run these metrics against your historical data ( you do have historical data as much you think you may not), and see who pops up at the top. Again, I will bet a dollar that you might be surprised.

So you see, analytics is not a separate "reporting only" solution. You can use it to make intelligent decisions. But if you are reading this blog and haven't slept yet, you already knew that. That is why I think analytics has implications in all three of the major categories in achieving a true ACO.

ACO Series Part II: Care Coordination, Quality Improvement and Utilization Management

Coming soon to a blog near you.

Plug and Play Business Intelligence?

As I was speaking to a potential client recently, I realized that someone had tried to sell her BI in a box. Even with our appliance Integra, I would not dare call it a plug and play solution. Why? There is so much that needs to happen before you get useful information out of your BI initiative. Out of the box, Integra includes the following:

· The ETL (extract, transform and load) software required to connect and integrate data.

· A semantic dictionary of healthcare terms for mapping source data to target data

· A data warehouse (customizable to house EMR, financial and other data).

· Pre-loaded metrics

· A fully integrated BI reporting solution.

· Pre-built reports.

· The hardware to house all this.

And you still wouldn't call that BI in a box, you ask? Absolutely not! And here is why. Even with all of this functionality built in, there is one thing missing. No prizes for guessing what it is. What is missing is “YOUR" data! Guess what, without that, the greatest BI in a box solution won't be of much use to you.

So let's take a look at what needs to happen before this becomes the BI 'Solution' that works for YOUR organization.

· Implementation Planning – During this initial phase the following will occur:

o Gather full set of reporting requirements.

o Gather testing requirements.

o Gather production deployment requirements.

o Identification of systems of record (SOR) and the tables/fields needed to satisfy the end reporting requirements.

o Mapping documents for each SOR are created. These documents include:

§ Source field name, data type and format.

§ Target field name, data type and format.

§ Cleansing requirements for each field.

§ Business logic needed to translate from source to target.

o Create development, testing and implementation plans for the next phases of this project.

· Customization – The actual customizations are created during this phase.

o Data for each SOR is gathered.

o Cleansing ETL processes are created for each source record.

o ETL processes are created and unit tested for each SOR.

o Reporting cube(s) are customized to support reporting requirements.

o Reports are created/customized and unit tested to requirements.

o At the end of this phase, the hardware is delivered to your site and the processes are connected to your SORs.

· Testing – Testing will be performed to the requirements which typically includes:

o Systems Integration Test (SIT) – Full nightly runs are performed and system is tested for correct technical functionality.

o User Acceptance Test (UAT) – A test bed of users are allowed to use the system to ensure requirements have been met from a business/clinical viewpoint.

· Production Deployment – The system is moved to your production environment and the system is made available to your users for consumption.

So folks, next time someone tells you that there is a plug and play solution for BI that does all of these things automagically, please call me right away! I would like to see this wondrous new thing and pay my respects. You can reach me at kishore@metaanalytix.com

Mental Health

Ok, so this is not really a blog post, but thought I'd let you know that we have now partnered with a Mental Health screening provider to provide analytics. You can read the press release here:

http://www.metaanalytix.com/upload/File/Meta%20Analytix_Medical_Outcomes_PressRelease.pdf

Accountable Care Organization - Achievable?

What is an ACO?

Here is a recent example of an ACO definition taken from a 2010 article co-authored by Elliot Fisher:

ACOs consist of providers who are jointly held accountable for achieving measured quality improvements [note that “measured quality improvements” is synonymous with report cards] and reductions in the rate of spending growth. Our definition emphasizes that these cost and quality improvements must achieve overall, per capita improvements in quality and cost, and that ACOs should have at least limited accountability for achieving these improvements while caring for a defined population of patients.

ACOs may involve a variety of provider configurations, ranging from integrated delivery systems and primary care medical groups to hospital-based systems and virtual networks of physicians such as independent practice associations. All accountable care organizations should have a strong base of primary care. Hospitals should be encouraged to participate, because improving hospital care is likely to be essential to success. But in contrast to others’ definitions, we believe that this need not be an absolute requirement for all ACOs (Mark McClellan et al., “A national strategy to put accountable care into practice,” Health Affairs 2010;29:982-990).

Hmmmm....confused enough? Well, in my ongoing quest to simplify or "Englishify" everything, I'll take a stab at it in my own way. The basic premise of an ACO is this:

1. Improve Quality of Care

2. Reduce Cost

3. We will hold you accountable for 1 and 2. Simple enough? Not so fast....

Someone once told me, "if you ask a question once, you might look dumb. But if you don't ask it, you'll stay that way". So here are the questions:

1. Who is going to hold you accountable? (Let's say CMS)

2. How are they going to hold you accountable? (Let's say they come up with measures that you have to track and report)

3. Define "defined patient populations"? (This my friends, I have no idea what it means)

So my real question is, if they do come up with the answers to the questions above and define ACOs, is it an achievable goal? The answer is, Absolutely! Improving quality of care while reducing cost of care is a very achievable goal. In fact, you should do it before they make you do it! The technology exists today. All you have to do is take one look at our KnowledgePath report and go home happy knowing that you have the technology and reporting capabilities available at your fingertips.

Informatics for Improving Quality of Care

A well designed informatics platform can not only improve profitability among healthcare providers, but allow for “Improved Quality of Care”. This white paper provides the possibilities, design considerations and thought leadership in designing and implementing scalable information architecture for Healthcare Providers to improve quality of care through research. You can download the whitepaper here: http://www.metaanalytix.com/page.php?page=33