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While much has been written about the philosophical underpinnings, goals, governance requirements, organizational models, economic theory and possible benefits of commercial and Medicare accountable care organizations (ACOs), relatively little has been said about the technology infrastructure that is required for successful operation of an ACO. Some contend that the definition of an ACO is nebulous or that there are too many ACO definitions. The definitional question and uncertainty about the operational “plumbing” of an ACO led one speaker at a major conference on ACOs in October 2010 to quip that “ACO stands for another consulting opportunity.”
Yet much progress has already been made in the commercial ACO arena – there are several commercial payer-led ACOs, which have been in operation for some time now and have shown positive results – and as of this writing, in weeks or perhaps just days, the Centers for Medicare & Medicaid Services is expected to issue a draft regulation on the Medicare Shared Savings Program that will provide greater definitional clarity and present proposed “rules of the game” for ACOs.
The following ACO Technology Framework lays out and describes the technology components needed for both Medicare and commercial ACOs. It is based on public policy analysis, input from providers and payers currently developing ACOs, and extensive market research, including literature review and nationwide focus groups involving many payer and provider organizations which are leaders in the ACO area.
At a high level, there are six technology components that are essential for the successful operation of an ACO.
Role-Based Security
This component is presented at the bottom of the diagram because trust between stakeholders is absolutely critical for ACOs. To develop and maintain trust, access to data must be managed carefully. Accordingly, ACOs need a secure, online environment that allow for controlled access to and sharing of data on a variety of levels between stakeholders (hospitals, physician practices, payers).
Clinical Data Exchange
The compilation and sharing of patient-specific data between the hospital and a patient’s primary care physician are central to the diagnosis and treatment, as well as the achievement of the ACO’s objectives.
Data Aggregation
ACOs require a meaningful joining of data from payers, hospitals, physicians and ancillary providers to create a holistic view of a population’s care experience.
Performance Management
Making the data actionable is critical for an ACO. To that end and ideally, performance management will include dynamic scorecards, dashboards, and summary and detail reports supported by proactive alerts and work lists in a collaborative environment.
Reporting Infrastructure
An ACO requires a system to share performance data (e.g., clinical quality, financial) with the payer, governance team and relevant stakeholders.
Financial Infrastructure
This final component enables the acceptance, tracking and allocation of payments (the ACO’s portion of shared savings) associated with performance results.
As with the different elements of buildings, these technology components are interrelated and synergistic. Each one of them constitutes an essential building block of an effective ACO.
Ken Perez is senior vice president of marketing for MedeAnalytics, a provider of healthcare performance management solutions. He leads the strategic direction and orchestration of all of MedeAnalytics marketing functions, including product management, product marketing and marketing communications.
