6. The Data Provide Valuable Insights
ACOs collect a great deal of data on patients' utilization of services and outcomes of care. Metrics are broken down by physician, and individually reported to them to guide them in creating care plans.
"The advantage of having the data is that you know a lot more about your patient, and that helps you improve cost and quality measures," Dr Habis says. Without it, PCPs have little way of knowing when patients go out of network to get care—something that can put a damper on the ACO's potential to earn a bonus.
"What the data show can be surprising," Dr Habis says. "At Meritage, we thought our care coordination was relatively good, until we started discovering through the data that patients were being lost to follow-up, poorly compliant, and confused about discharge instructions. Patients were falling through the cracks."
At NewHealth, Dr Dera says the metrics help PCPs follow patients, even those who aren't in front of them in the exam room. "As a practicing family physician, I need to be able to identify patients not seen, care gaps, and the ever-important 'hot-spotter' patients who need more-intensive care," he says. "The data help me do this."
At Palm Beach, Dr Sukienik says he and other ACO representatives rely heavily on data in their regular meetings with each ACO physician. "The data are a great educational tool," he says.
Dr Dera cautions that it's not just data, but the kind of data being used, that's important. "If you just use claims data," he says, "you'll get an incomplete picture." Medicare claims data are many months old and won't show past care, such as a colonoscopy paid for by a commercial insurer before the patient signed up for Medicare, he explains.
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Cite this: Leigh Page. 10 Things You Need to Know to Succeed and Be Happy in an ACO - Medscape - Jul 28, 2015.