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

Information Based Design - Next Gen Data Warehouses

Recently, in my webinar done jointly with expressor, I was asked a question: "Is the best practice for deploying warehouses a "single, enterprise wide warehouse" or a warehouse with different data marts for each line of business?" My answer was "it depends on the client". Very simply said. As I was talking to a colleague of mine, we knew the answer wasn't that simple and we decided to write a whitepaper about it. So here we are, with a brand new, hot off the press (or Adobe for that matter), FREE whitepaper on "Information Based Design - Next Generation Data Warehouses for Healthcare providers". Here is an excerpt from the whitepaper:

"Very large companies can afford big investments and long lead times to build out new enterprise data warehouse environments. These can be several year projects that cost tens of millions of dollars, or more. Success (based on full achievement of the initial vision) is far from guaranteed. Not uncommonly, after several years, planning for the “next generation” data warehouse begins to take root and the process begins anew… Meta Analytix and End to End solutions present a white paper on Information Based, Incremental, Data Warehouse design for those organizations with limited time and budgets."

Continue to White Paper here: http://www.metaanalytix.com/page.php?page=15

Active vs. Passive Intelligence

During a recent webinar I gave, I was asked about delivering intelligence to the end user. It got me thinking as to what are the best ways to deliver information in the "I have the smallest device I can fit in my eye coolest toy that you don't have" era?

As any good technologist would do, I thought about the different types of users and how they would access information. Then I thought about "what" information they needed. So, in a healthcare informatics setting (after all, that is what we are talking about here), to me, there are two types of users who could benefit from informatics. The Active Intelligence Users and the Passive Intelligence users.

Active Intelligence:

Take an ER doc, for example. She sees a multitude of patients in a single day, works ungodly hours (trust me, I know a few) and probably works in more than one hospital. If you asked her if she is up to date on the latest research in heart conditions (after all, if you have a heart attack, you are not going to your local world renowned cardiologist, you are running to the ER), she would either laugh at you or worse, walk away in a huff, vowing never to speak to you again. Enter the words that we are all familiar with, Clinical Decision Support. This is a form of active intelligence. Delivery of information to the end user ( our heroine in this case ), at the "point of care", where she can quickly browse through the latest guidelines on heart conditions before seeing the patient or fancier still, input patient information directly into her "eyeball wearable device" and the suggestions are automagically transferred to her brain.

Passive Intelligence:

Passive intelligence in much simpler, but not any less important. We have always heard that "history is a good teacher" (whether we listen to history is another question altogether), but for the sake of this blog, let's say history is indeed, a good teacher. Who are the cool customers of this type of intelligence? Your researchers, your administrators and the people who have to run the "business of healthcare".

So, there you have it, two broad categories of intelligence (and I am sure some of you may have thought of umpteen number of other types of intelligences), but that's your problem!

Metadata for Healthcare

In my webinar, I spoke of how expressor helps you manage metadata "in-process" rather than as an afterthought. Dr. David Fenstermacher, Chair and Executive Director of the Department of Biomedical Informatics at the H. Lee Moffitt Cancer Center & Research Institute is giving a webinar on "Metadata, the cornerstone of tomorrow's healthcare information systems", a more detailed dive into the use of metadata. It's Free. You can register for the webinar here:

http://pages.expressor-software.com/metadata-the-cornerstone-for-tomorrows-healthcare-IMS-webinar.html

Meaningful Use - Final Rule - Again!

Ok,

So my sales team twisted my arm to put this on here. So, please bear with me: Here it goes.

By now, you have all read the 864 page meaningful use Final Rule and are prepared to be compliant right? Well, if not, we’d like to talk to you about Compliance Reporting for Meaningful Use.

As you may already know, there are 15 core measures that you have to electronically report to CMS to be compliant. And you may already know that a CCHIT certified EHR alone is not going to help you get there. Let us take a moment to introduce you to Meta Analytix’s comprehensive informatics platform designed specifically for Healthcare, Integra.

As a savvy executive, you already know what Informatics can bring to the table in increasing profitability, improving your organization’s competitiveness in the marketplace and having a single view of your entire organization. Some of the statistics that you may not know are these. Best in class Hospitals that have used centralized business intelligence have achieved:

* Increased profitability from 1%-9% (Aberdeen Research)

* An average of 36 days to receive payment on accounts vs. 46 days for all others (Aberdeen Research)

* A nurse turnover rate of 10% vs. 14% for all others (Aberdeen Research)

Given this scenario, how can we help? Take a look at the salient features of Integra

* Over 400 Healthcare measures pre-loaded, including meaningful use measures

* Enterprise Class ETL platform built in (http://expressor-software.com).

* Can acquire data from your EHR software, SAS, COBOL and others

* Standardized data definitions pre-loaded for Healthcare

* Flex Dimensional^TM Data Model ready for staging and reporting

* Enterprise Open Source BI platform for reporting, drill down analysis and dashboard building.

* Low Total Cost of Ownership (TCO)

* Low implementation lifecycle. (Avoid making costly purchases of individual components and building from scratch)

* Experienced Consultants to work with you to implement your informatics platform seamlessly with minimal workflow interruption

As you can see, Integra is the only informatics platform pre-built for Healthcare and ready to get you to to Meaningful Use in the quickest possible time. For additional information, please see the attached brochure or visit our website: http://www.metaanalytix.com

Contact us for a demo or for your consulting needs:

Phone: 866.611.8595 Ext. 1 or Ext. 2

Email: info@metaanalytix.com

Meaningful Use - Final Rule

The final rule for meaningful use is here, finally! The good news? Number of measures have gone down. The bad news? It is more complex to collect and report. Take for example the following stage 1 measure as defined in the final rule :

"More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department

(POS 21 or 23) have at least one medication order entered using CPOE".

Huh? Think about it. What would the measure for this look like? Let's say the measure looks like this: "% of patients seen by EP (Eligible Professional) in Emergency Department or Inpatient with at least one medication order entered using CPOE".

Easy enough? Not so fast, my computer savvy analyst ( yes, you know who you are...usually known as the "data queen" in your organization). Think about the data elements you have to collect.

Let's break down the measure into chunks to better understand it:

1. Number of patients who was seen by an EP (Eligible Professional) - Who are eligible professionals? (We won't go into the definition here, but if you are so inclined, you can read page 358 of the meaningful use rule to find out.) Bottom line for you to make this measure work, you will have to find out the "type of provider". This information is stored where now? In your HR database, I presume?

2. Seen in an Emergency Department or Inpatient facility: Ok, so what happens if a patient was seen both by your ER and then admitted to your Inpatient facility? No matter, we can work around it, by looking at whether the patient was treated by an ER doc before she was sent to inpatient, right? Where is the data for this? Well, the EMR guys should have this info for sure, right?

3. Medications that are on the medication list ordered by CPOE. Well, the EMR guys should have this data too, correct? Great. It's 2 for EMR, one for HR!

4. Hmmmm....what is the fourth element? Do we have all we need? Not yet, data queen. To calculate this measure, you also need to know the total number of patients who were seen and who were ordered medications "without" the use of CPOE. Where is the data for that?!!! Your appointment scheduling system? Maybe your claims system? Doctors' notes?

Final score? Measure - 1. DQ - 0. The point, I am making, is invest in a really good Informatics platform. The measures are not going away and they are getting more complex. Once in place, you, my dear DQ, will be able to pull this data at the click of a button, or better still, program it to run automatically and send a PDF to your boss as an email attachment!