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Improving ACO Efficiency and Effectiveness: Getting the Data You Want and Need

Posted by  admin  Mar 2, 2017

March 2, 2017

By Howard Beckman, MD, FACP, FAACH, Chief Medical Officer – EagleDream Health

This was originally published on the EagleDream Health Blog on August 26, 2017.

Recently, Song and Fisher published a Viewpoint in JAMAentitled, “The ACO experiment in infancy – Looking Back and Looking Forward”.  In the piece, they note three data related capabilities ACOs need to succeed; each of which EagleDream Health provides to its customers.

First, the authors state, “If internal incentives or transparency in performance among physicians help motivate improvement, ACOs can apportion a part of the budget toward those goals”.

Through its’ PERFORM module, EagleDream Health offers a unique capability for ACOs to a) identify the cost drivers for high cost, high volume diagnostic conditions for each contracted specialty, b) create variation curves that highlight the differences in the utilization of those cost drivers by physician or practice group, and c) tie that practitioner variation report to the use of “low value services”. It is precisely the variation in low value services that drives short term performance of the ACO in risk and gain sharing contracts.

Identifying and reducing overuse of low value services that offer little in improving quality provides short term savings that can be used to fund improvements in chronic disease management programs. Our experience is that practitioners find accurate peer comparison data, delivered in a non-judgmental fashion to be the most significant driver of behavior change; the very intervention ACO leaders are seeking.

Second, in both ACO populations, physician led and hospital/physician led ACOs, bonuses for ACOs are highly contingent on achieving gains in quality. Through its’ INFORM module, EagleDream Health offer state of the art quality reporting that can be individualized to focus on specific contracts and measure sets. For example, Medicare may focus on one set of measures while a commercial plan chooses different measures. INFORM allows tracking for both payers’ measures, reporting results over time. Registries are created, patients in need of services identified both when in need of a service but also in the months before the service expires, reducing the population out of compliance. INFORM offers care managers the quality information to succeed at helping practitioners meet their quality targets.

Finally, Song and Fisher note that, “Changes in referral patterns toward lower-priced physicians and hospitals explained most of the savings in the initial years, while reductions in utilization played a larger role over time.” One of the most exciting components of EagleDream Health’s PERFORM module is termed network design and management. The client defines who is in- and out-of-network with in-network having the capacity to distinguish those who are employed, closely affiliated or peripherally affiliated with the ACO. It also has a special feature that identifies services out-of-network because the ACO does not have practitioners who supply those services. Examples are often podiatry and chiropractic care. PERFORM identifies from whom out-of-network services are referred but also to whom referrals are sent. This allows the ACO to determine where to focus most attention. In addition, a geo-spatial feature lets ACO leadership see the extent to which geography contributes to out of network referrals. Based on this data, ACOs can design their network more effectively, recruit those to locations where there are gaps in access and provide feedback on the efficiency of both in network and out of network practitioners.

EagleDream Health provides the data management services ACOs need to improve both the efficiency and efficacy of care provided. With strong physician leadership, EagleDream Health focuses on creating accurate, risk adjusted, actionable data to help ACOs provide meaningful data to their members. We look forward to speaking with you about our services. For those interested, please contact Mike Howard, SVP of Business Development at mike.howard@eagledreamhealth.com.

  1. Song Z, Fisher ES. The ACO Experiment in Infancy – Looking Back and Looking Forward. JAMA. 2016;316(7):705-706.