21 Questions for ACOs Regarding Analytics

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The following is an excerpt from a complete white paper by Singletrack Analytics on analytics for ACOs. The download the entire whitepaper, click here (pdf).
The questions below represent important metrics that will drive the financial success of the organization. ACOs should ensure that their analytics systems to provide this information on an accurate and timely basis.

Primary care physicians

1. What’s the average PMPM (per member per month) cost of the ACO? What’s the distribution of the costs? Are there high-cost outlier patients?

2. What’s the age and gender mix of the patients?

3. What’s the average severity of the PCP’s patient population as measured by their HCC score?

4. What patients might be helped by disease management programs offered by the ACO?

5. Where are the PCPs patients admitted?  Will this PCP create leakage?

6. What drugs do the PCP’s patients take?  What’s the percentage of brand to generic drugs? What drugs are taken for the most common HCCs that are treated by drugs?

7. To which specialists does this PCP most commonly refer? Are those specialists likely to be involved in the cost reduction and utilization management processes of the ACO?

8. What medications are prescribed by this physician for common diagnoses?

9. Histogram of patient count by cost category

10. Histogram of patient count by HCC

11. What’s the mix of services provided to various types of patients? For patients with a specific condition (HCC), how does this specialist generally treat them?

12. Where does the specialist admit patients?  

13. Does the specialist have a large number of consulting physician visits associated with procedures?

14. What medications are prescribed by this physician for common diagnoses?

15. What are the averages lengths of stay for this physician’s patients in common DRGs as compared to the physician’s peers?

16. What’s the readmission rate for this physician for high-volume DRGs?

17. Which physicians in each specialty have the greatest number of readmissions?

18. Which DRGs or diagnosis groups have significant readmissions?

Out of network hospitals

19. Which out-of-network hospitals capture admissions from the ACO’s patient base? For which DRGs?  From which referring/admitting physicians? To what extent are these referrals driven by the patient’s home location (convenience)?

20. For commercial (non-Medicare) patients, what rates are the non-network hospitals paid?  What is the cost to the ACO of an admission to non-network hospitals?

Post-acute providers
21. Which post-acute providers receive patients from the ACO’s providers?  For which conditions/DRGs?  What payments rates are paid to these providers?  

Singletrack Analytics is a healthcare financial and data consulting firm specializing in assisting healthcare providers and purchasers achieve success through better use of data and analytic techniques. For information about Singletrack Analytics, please visit www.singletrackanalytics.com or email at info@singletrackanalytics.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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