How we must support ACOs

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Feb 14, 2018

PHM functionality and mindset

I’ve been talking a lot about ACOs lately (HIStalking, for one) and stressing how important it is that population health management technology and approaches (analytics around patient risk and care caps and finding the right workflow fit for care managers, for example) are keys to success within large ACO structures.

If you haven’t seen it, an analysis of how high-performing ACOs are making strides is examined in this Health Affairs post from January 29 titled “How the Most Successful ACOs Act as Factories of Innovation.”

We’ve all seen the numbers from earlier this year: participation in ACOs is up overall, and notably up within higher CMS risk models such as Next Generation and Track1+. And combined with commercial ACOs, the next milestone is 1,000 ACOs operating nationwide, making them the most far-reaching successes in value-based care.

At Philips Wellcentive, we support multiple customers in various stages of MSSP migration and commercial contracts. We are particularly excited to support Children’s Health Alliance (CHA) within its role in developing the first-ever pediatric ACO in the state of Oregon. Maybe not coincidentally, JAMA last September called for uniform quality measures for pediatric care, though we’ve been helping CHA with quality metrics for some time.

“Configuring effective PHM programs”

Back to the Health Affairs analysis, its authors focused on three key areas high-performing ACOs pursue:

  • A high-value culture around ACO goals and buy-in
  • Establishing continuous improvement structures
  • Configuring effective population health management programs

No surprise I read the best practices around PHM programs, what I’m referring to as the mindset, with great interest. Here are some common denominators found:

  • Better management of chronically ill patients (Check, we’ve been stressing that for years.)
  • Strategically embedding care managers (Yes, they are key to focusing on analytics results showing risk levels and care gaps and can lead to better patient self- management.)
  • Basing incentives and compensation on VBC performance, in one case through the creation of a care management impact score (Great idea and we know that some progressive large health systems have already started basing C Suite compensation on population-based metrics.)

Merging programs with PHM technology

These are all great ideas, and once a system has settled on workflow or clinical goals and processes, of course they must merge with PHM technology.

As KLAS began talking to PHM platform customers beginning in 2013, we helped them at the Keystone Summit create six criteria for comprehensive PHM evaluations:

  • aggregation
  • analytics
  • care coordination
  • financial/administrative
  • patient engagement
  • clinician engagement

Accent on EMR integration

More recently, and to the organization’s credit, KLAS has been examining just what PHM platform tools will get you there. Dominating the short list is EMR integration.

I couldn’t agree more, as EMR rip and replace is not necessary given the comprehensive PHM platforms that can interface with and free data from the EMRs, and, via Philips Wellcentive technology, put scrubbed data back into the EMR.

But first, KLAS noted other needed variations of EMR integration, such as seeing a care gap need from the PHM tool and the ability to “take action in the EMR”, all within workflow, along with the ability to integrate with multiple EMR platforms.

How we’re integrating for ACO customers

To benefit ACO reporting, we’ve been working with a very well-known EMR firm to aggregate data from disparate EMRs within a large health system and mutual customer, and then place needed data back into the EMR for the quality reporting. We’re calling this an outbounds project, and that’s what KLAS is getting at.

For another of our customers, the CHRISTUS Health ACO, we routinely integrate with 25 disparate EMRs and aggregate data for ACO reporting and many other clinical and organizational needs.

What it all comes down to is if ACOs are the cornerstone of value-based care, and I believe they are, then PHM processes and technology has to prop that cornerstone up, and do so increasingly by working with EMRs, third-party apps, API technologies and all stakeholders driven by value, scalability and outcomes.

About the author

Niki Buchanan

Niki Buchanan, 
General Manager & Business Leader, Philips

Niki Buchanan is General Manager & Business Leader for Philips PHM. A dynamic and versatile healthcare executive, Niki uses her distinctive customer satisfaction and product optimization methodology to lead improvements across the Health IT spectrum.

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