ACO Analytics: The good, the bad and the ugly

Speaker Mical DeBrow, PhD RN Director, Health Analytics and Business Intelligence G2 Works

Drivers of Healthcare 2015

The data avalanche is here…

The Goal? Data Knowledge Action

Use a SMARTER Approach Specific Measurable Assignable Realistic Time-bound Evaluate Re-evaluate

Analytics and Data are NOT just Cost Centers

Do ACOs have you tied up in knots?

What is an Accountable Care Organization?

Why should you care?

What kind of risk are we talking about?

How is efficiency measured?

Four Domains Patient/caregiver experience – Consumer Assessment of Healthcare Providers and Systems (CAHPS) Care coordination and patient safety At-risk population Preventive health Extra slide

The Ugly Domains and measures are subject to change annually 30% shift in traditional Medicare to quality/value alternative models (such as ACOs) by the end of 2015 50% shift in traditional Medicare to quality/value alternative models (such as ACOs) by the end of 2018 Even higher percentages through Value-based Purchasing and Hospital Readmission Reduction Programs (85%, by 2015; 90%, by 2018) Extra slide

Thou Shalt Not Boil the Ocean

What Should You Be Doing? Engage with providers and payers Choose or adapt the vehicle for your ACO Do you belong to more than one ACO? Assess your capabilities to access and measure populations and health analytics

How Analytics Sustain an ACO Care coordination Population health Decreased costs and increased reimbursements Patient experience

Use analytics to drive the business of healthcare, NOT only report it!

The key to unlocking information…

Data Governance Data Quality Privacy and Security Communications and Awareness Policy and Standards Technology and Infrastructure Compliance

Other Items to Consider Population health—what does that really mean? Decreasing costs, increasing reimbursements Improving the patient experience

Lessons Before You Learn Build a solid foundation Integrate ALL data Ensure that data is validated against known sources Start with small wins at high levels

More Lessons Gain clinical, financial and operational buy-in Set appropriate expectations Allocate appropriate funding Determine the model you can support

Ancora imparo: Still, I am Learning Plan for future process needs Create enterprise-wide definitions Don’t bite off more than can be resourced Involve end-users only when the timing is right

Health Analytics Must Continue to Evolve Retrospective Concurrent Predictive Prescriptive What’s Next?

Things to Think About Is there agreement on what to measure? Are there realistic goals or targets? Is an upward or downward trend better? Is there such a thing as “too good?” Are there critical thresholds? Can anything be done to affect the measure?

And the Analytics Just Keep Coming Two-Midnight Rule or Short Stay Admissions Meaningful Use 3 Recovery Audit Contractor program resumes Value-based Purchasing (actually, Quality-based Reimbursement) Hospital Readmission Reduction Program Patient Safety Indicators (PSI 90)

Putting It All Together

Questions?

Thank You! mical.debrow@g2works.com