Analytic support for an Accountable Care Organization

Challenge

For both public and private payers, ACOs have begun to play a role in efforts to manage the rising cost of health care. In such an arrangement, a provider system enters into an agreement with the payer to oversee care for a defined patient population; the agreement specifies measures for how well the provider controls cost and maintains quality. The payer and the provider share savings resulting from successful cost control – reducing cost measures below agreed-upon target values, while still meeting quality standards. (Some agreements may also require the provider to share in losses – when the provider fails to reduce cost measures to meet target values.)

A provider system taking on this population health management responsibility receives ongoing data streams about services the relevant patients consume – services delivered both within the ACO provider system and by other providers – so it can monitor its performance against the cost and quality targets specified by the agreement. Management of, and access to, this complex data resource is critical to population health management.

Our client had entered into multiple ACO arrangements with public and private payers. Leadership wanted to manage patient care with a common strategy and monitor progress toward performance targets. They engaged BerryDunn to receive all of the data streams describing services members consumed, to store the data securely in a common format across ACOs, and to produce regular reports and analyses.

Approach

BerryDunn advisors analyzed commonalities and differences among the various ACO data streams and structured a data store to accommodate both. We built and designed the tables, generated monthly updates, and adapted the process as necessary to handle changes in the incoming data streams. We made the resulting data stores available to ACO staff so they could perform their own analyses.

BerryDunn advisors worked with the ACO data scientist to:

• Examine the quality and completeness of each population’s data and, to the extent possible, compensate for deficits
• Assign risk scores appropriate to the population
• Produce reports enabling primary care organizations within the system to gain insight into their relative performance on measures of efficiency and quality
• Analyze each population’s use of services from providers outside the (ACO provider) system
• Use standard service payment rates to assign prices to claims to analyze service intensity (facilitating a comparison of relative costs of services) in cases where the payer would not reveal actual costs
• Highlight opportunities to reduce cost of the provider system’s insured employee population
• Gain insight into the potential viability of the ACO

Outcome

The provider system was able to generate accurate, actionable information to support its population health management efforts in a fraction of the time and at a smaller cost than in earlier attempts with other vendors. BerryDunn is now a trusted partner in the provider system’s efforts to deliver efficient, high-quality care to ACO populations.