As has occurred in most demonstration programs in the past, CMS is expected to send ACO applicants the historical data for the members that will be attributed to the ACO's primary care physicians. But what should you do with that data? Time to crank up Excel and go to work?
Analytics can't be an afterthought for ACOs. It can't be something that's loaded onto the overworked hospital accountant who's already preparing the financial justification for the new linear accelerator and reconciling last year's Blue Cross payments. It can't be done in spreadsheets. It's too important to be relegated to lower-level staff. Having robust, timely and accurate analytics is a key competitive edge for an ACO. It needs to be integrated into the strategy and management structure of the organization, and woven throughout its activities.
Integrating analytics into an ACO is a large task. Let's leave that discussion for another day. Today we'll just focus on what to do with the initial set of data when it arrives from CMS. There are several areas of critical analytics that you'll want to review from this data. You'll want to profile the demographics of your PCPs' members - the ones that CMS just assigned to you - to know their ages, where they live, and what medical services they use. You'll want to know if your PCPs refer to specialists and hospitals outside of your network. You'll want to identify the patients with chronic diseases so that you can get them into your disease management program (you DO have a disease management program, right?) as quickly as possible. You want to check out the risk scores of your PCPs, and the overall scores for the ACO, so that you can start to understand if you have a possibility of getting a bonus payment from CMS.
These processes are detailed in a white paper by Singletrack Analytics, which is available on our website at http://www.singletrackanalytics.com/Articles___White_Papers.html. Hopefully you'll find it interesting and informative. Call us if you have any questions about what to do next.