The first big hurdle for accountable care organizations is creating an environment of collaboration for care coordination, Joel Vengco, vice president and chief information officer of Baystate Health, says in an interview at Healthcare Informatics.
Baystate Health is made up of six hospitals, 80 medical groups and its own health plan, Health New England. It joined the Medicare Shared Savings Program for ACOs in 2012, with its Pioneer Valley Accountable Care organization.
While bringing together an array of providers in a region presents a challenge, other aspects, including making meaningful use of analytics are more difficult than they seem, he says.
"The lesson here is that you have to take your time in curating and normalizing and standardizing the data, so that your analytics will be as precise as you can make them. Stratification becomes possible when predictive modeling becomes possible, but only when you're able to extract the data and normalize it," he says.
A second lesson from analytics: Creating reports and dashboards is great, but clinicians need something they can actually use to manage their population.
The Baystate medical practices meet quarterly to review their metrics, he says, including 30-day readmissions and where there are high rates of non-reimbursable utilization.
"If you leave them to their devices and give them a report card, but there's no carrot or stick, it can be ignored. So having those collaborative sessions is very important," Vengco says.
Medicare accountable care organizations saved $411 million in 2014, but few of the Pioneer and Medicare Shared Savings Program ACOs qualified for bonuses in the second year of the program. Baystate saved $2.5 million to $3 million in the first year and slightly more in the second year, but still fell below the 2 percent threshold required to get savings back, Vengco said.
With little of physician pay so far linked to quality measures, joining an ACO might not be a matter of urgency for most practices, according to an article from the American Academy of Family Physicians. However, that's expected to change,
Despite early problems with the model, Paul Keckley, Ph.D., managing director of the Navigant Center for Healthcare Research and Policy Analysis, expects ACOs to survive--and thrive. He calls them "the most significant foundation in the transformation of the U.S. health system."
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