A Florida ACO's lessons on how to succeed in risk contracts

To succeed in value-based and risk-based contracts, accountable care organizations (ACOs) must be able to collect, aggregate, normalize and analyze data from a wide variety of sources.

Only by giving their clinicians access to a holistic view of their patients across care settings can they lower costs and improve clinical outcomes—the keys to thriving under value-based reimbursement.

Millennium Physician Group, the Fort Myers, Fla., practice of which I am the CIO, operates an ACO that has consistently done well in the Medicare Shared Savings Program (MSSP). Participating in track 3 of the MSSP, which entails upside and downside risk, we netted $18.5 million in shared savings in 2016, which was one of the best performances for ACOs in the program. And this was the fourth year in a row in which we garnered MSSP shared savings.

We give much of the credit to our enterprise data warehouse (EDW), which has allowed us to combine Medicare claims data with clinical data from across the spectrum of care. These data sources include our electronic health record (EHR), the EHR of a family medicine group that belongs to the ACO, and the Florida Health Information Exchange, which supplies data from outside specialists, hospitals, skilled nursing facilities and other providers.

The EDW enables us to normalize all of this data on a single platform and analyze it so we can send actionable intelligence to our providers at the point of care. As a result, our primary care physicians can see the relevant financial and clinical data for all of their attributed patients.

This holistic view, which goes far beyond what is in their own EHRs, shows them their patients’ care gaps and helps them avoid redundant, unnecessary tests and procedures.

The Florida HIE also sends alerts to the ACO about our patients’ emergency department (ED) visits, hospital admissions and discharges. The patterns of individual patients’ ED visits and hospitalizations, coupled with other data about their contacts with the healthcare system, give our case managers insights into why these patients are using these costly types of care so often.

The alerts also enable the case managers to act right away to get discharged patients into transitional care management or other programs. This timely intervention, based on near-real-time data, can help prevent readmissions or admissions if the patients go to a hospital’s ED.

Moving forward, we plan to give our patients the same holistic view of data that our clinicians already have. The goal is to engage patients more in prevention and in managing their chronic conditions. This kind of patient engagement has become increasingly critical to ACOs as the MSSP benchmarks we must beat to get shared savings continue to drop.

Data is instrumental to succeeding in a value-based contract, especially if it involves financial risk. And the only way for an ACO to manage that data is by pulling it together from a variety of sources in an enterprise data warehouse. By using the analytics in our EDW to create a holistic view of each patient, we are giving our clinicians the tools they need to help us lower the total cost of care while improving quality and outcomes.

Jeffrey Nelson is CIO of the Millennium Physician Group, based in Fort Myers, Fla.

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