healt h care a na ly t i c s
I expect that by 2017, analytics will
drive success for ACOs across the board.
That’s good news for analytics professionals and product companies. The needle has started to move at last.
Cost and return on investment of data analytics solutions pose significant barriers
to adoption within many organizations.
Pioneer ACO Data Shows
Challenges Ahead
CMS designed the ACO model to improve care by sharing data among multiple
stakeholders. ACOs are a cornerstone of
the Affordable Care Act (ACA). The idea is
that by focusing on the holistic picture of a
patient as they move through the healthcare system, providers can not only prevent
wasteful duplication of diagnostic tests and
procedures, but can also deliver the right
care at the right time to the right patient.
Such targeted intervention in turn will help
in the prevention of unnecessary emergency room visits and costly hospital readmissions. Patients do not want to spend time
in the hospital, so reduced hospitalizations
and better health for individuals will drive up
patient satisfaction. This is the “triple aim”
that ACA wants the healthcare industry to
move toward. The majority of ACOs, however, are far from achieving that goal. They
have not found much success in improving
key performance indicators such as patient
safety, cost containment, efficiency and patient satisfaction [2].
Geisinger Health System, one of the
leading physician-led healthcare systems in the country, mined its huge data
sets, and it has found that an inverse
After a long wait, the Center for Medicare and Medicaid (CMS) recently published quality and financial data reported
from the Pioneer Accountable Care Organization (ACO) program. CMS started
the program in 2012 to improve quality
and health outcomes of patients by aligning payment incentives for providers. Of
the 32 original Pioneer ACOs who participated in the program, 60 percent posted
savings in the first year (2012) while 40
percent posted losses. The worrisome
thing is by the second year about 50 percent of the initial participants dropped off
the list. The cost incurred in the program
by those who dropped off was much higher than their savings.
However, CMS reported that in general
the program saved Medicare $96 million
in a two-year span. That is a good start,
but clearly ACOs have mountains to climb
in terms of data interoperability and data
analytics. A recent survey of 62 ACOs by
Premiere and eHealth Initiative found that
83 percent of ACOs are facing challenges
in integrating analytics into their workflow.
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What is Holding Back
Transformation?
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