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.