As the paradigm shifts from volume to value, accountable care organizations (ACO) will need to share data between providers and payers, according to experts at America's Health Insurance Plans' (AHIP) Summit on Shared Accountability in Washington, D.C., on Tuesday.
In what CIGNA calls its Collaborative Accountable Care approach, data sharing exists between the health plan and the providers, as well as internally.
The gainsharing program has a triple aim of lower costs, improved outcomes, and better patient satisfaction, according to Dr. Jeffrey Kang, CIGNA HealthCare's chief medical officer. (Kang recently announced he is leaving CIGNA after nine years for the newly created Walgreens's position of vice president of health and wellness services and solutions.)
Like the Centers for Medicare & Medicaid Services' (CMS) proposed accountable care program, CIGNA's collaborative accountable care approach looks at patients retrospectively. However, CIGNA also is aware of which patients they are caring for, prospectively, according to Kang.
Although CMS proposes medical record use in its accountable care approach, CIGNA aims for administrative simplicity by using claims data with administrative, evidence-based measures, Kang said.
Regarding patient satisfaction, CIGNA will most likely use Hospital Consumer Assessment of Healthcare Providers and Systems , otherwise known as HCAHPS, like many other organizations, Kang said.
Key to CIGNA's approach is that quality measures are tied to financial incentives.
"You have to hit quality targets in order to achieve any part of gainshare," Kang said.
The model has proven to be successful at the multispecialty practice Medical Clinics of North Texas in Dallas. After implementation, Medical Clinics saw 2 percent lower readmission rates and 2 percent lower utilization of high-tech radiology.
However, success didn't come without bumps in the road. Described as a dating relationship, they had ups and downs in the relationship, said Karen Kennedy, chief administrative officer at Medical Clinics. Kang noted that each came with a list of criteria to meet, but in the end, it was collaboration between the two organizations that helped each other ensure the match would work.
Kennedy also attributed the "quality journey" process to data sharing to help meet those targets. Medical Clinics measures physician performance and publishes those data publicly at group meetings. Individual physicians also receive monthly summary data.
In addition, the collaborative care model requires data sharing not just within the organizations but also between all payers to avoid market dominance, Kang said. While he applauds the Federal Trade Commission for their efforts, he said that anti-trust agencies must look at integrating organizations retrospectively and not only prospectively. He said it's challenging to determine which partnering organizations will really cut costs and who are in it for the monopoly. The government predicts that determination, but Kang calls on all payers (Medicare, Medicaid, and commercial) to share market data for more accurate predictions in monitoring the system. Sharing payer data could help the government protect cost savings and avoid market dominance, he said.
Data is critical in "learning to do this together," Kennedy said about accountable care. She added, "The role of health plans is changing."