Value-based care is predicted to grow 15% per year and is on target to double within the next five years. Accountable Care Organizations (ACOs) are poised to play a pivotal and growing role in the healthcare landscape, aiming to enhance patient outcomes while effectively managing costs. In fact, the Centers for Medicare and Medicaid Innovation announced they’d like to shift 100% of Medicare beneficiaries into an accountable-care relationship by 2030 – with commercial value-based care coverage predicted to double by 2027.
However, like many other parts of the healthcare system, an ACO’s effectiveness is hampered by the challenges posed by limited and non-standardized access to real-time patient clinical information.
How can healthcare providers in ACOs truly be accountable if they’re unaware a patient has received care beyond their walls? The answer seems simple enough: ACOs need comprehensive and real-time information about patients’ complete journeys through the healthcare system.
The challenge? Current technological solutions in the market ultimately fall short in providing the complete clinical picture – and they fail to empower ACOs to their full potential.
The Challenge of Incomplete Data
Existing ACO technology solutions primarily focus on sending notifications when a patient is admitted to a facility within or outside the ACO’s network. While these notifications are a step in the right direction, they only scratch the surface. ACOs often lack access to real-time clinical data while a patient is in an acute care setting which hinders their ability to make informed decisions and coordinate effective care.
The Piecemealed Approach
Another significant challenge for ACOs lies in the piecemealed approach to data access and sharing. Currently, ADT (Admission, Discharge and Transfer) feeds are commonly used to communicate to ACOs when a patient has been admitted, transferred, or discharged from a care setting. But ADTs are often incomplete across different care networks, geographies, and care settings – they often cannot convey all the relevant clinical information needed by the clinician to effectively engage with their patient in a timely manner. These issues prevent advanced technology solutions, particularly those utilizing artificial intelligence, from creating accurate and meaningful summaries and predictions based on patient data. Worse, ACOs have reported that notifications are sometimes irrelevant, because they can be received for services that do not require the ACO’s time or attention to understand if intervention is required. To move toward increased accountability and empowerment, ACOs not only need comprehensive patient clinical info to accompany relevant pings or alerts, but they need to be able to access this information in a centralized location, attuned to clinicians’ and administrative staff’s existing workflows and data sources.
Quality Measures and Informed Decision-Making
ACOs participating in certain federal programs are held accountable for various quality measures that are governed by the Centers for Medicare and Medicaid Services. If ACOs perform well against these quality measures, they can share savings via enhanced quality-based payments. But if ACOs perform poorly, they miss quality-related revenues. In addition, the disconnected nature of patient data – who has it, who needs it, how to get it in real-time – combined with the lack of incentives for healthcare entities to work together to use that data to improve care and create administrative efficiencies make it challenging for the entity accountable for managing care and costs. For ACOs to succeed they must have access to tools that transition them from being “responsible” to being “informed.” This requires that ACOs have access to more complete patient data for more intelligent decision-making that not only meets quality measures but positively impacts patient care.
The Call for Integrated Solutions to Deliver Value-Based Care
ACOs have long been limited by existing, fragmented tools or solutions that cannot provide notifications or comprehensive patient clinical information. Delivering this information in standardized, clinically relevant workflows, and in real time is increasingly being adopted by ACOs to help them deliver on their commitment to care for their attributed patient populations.
In fact, for the broader healthcare industry at large, one could say the successful implementation of value-based care hinges on the industry’s ability to manage care effectively, which is a task uniquely suited for ACOs. To fulfill their potential, ACOs must transition from being data-dependent to data-empowered. By leveraging technology that offers more comprehensive data, reduces noise, and enhances collaboration, ACOs can play a pivotal role in shaping a healthcare landscape that prioritizes better patient outcomes and cost-effective care.
XSOLIS sees this challenge and its solution, Dragonfly Notify for ACOs, as one of several newly available product offerings that will help the company deliver on its mission to create a frictionless healthcare system for all. Dragonfly Notify goes beyond notifications to also offer the most-needed but sorely missing tools ACOs need to succeed – including the comprehensive package of clinical data, and the ability to communicate in-app. No more piecemeal solutions to finally deliver the info and efficiency ACOs need to be accountable. Learn more here.
Michael Drescher is a seasoned healthcare and communications professional with more than 20 years’ experience helping organizations succeed and navigate complex environments. He currently serves as Vice President of Payer Strategy at Xsolis.
Matthew Brink has 15+years of experience harnessing his knowledge of nursing, IT, clinical concepts and healthcare delivery systems to help payers and providers translate current standards of care into more efficient solutions. He currently serves as Director, Payer Solutions at Xsolis.