ACOs: Four Ways Technology
Contributes to Success

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ACOs Contribute to Success with Technology
This report is based on a 2018 Healthcare Analytics Summit presentation
given by Joan E. Valentine, RN, MSA, Executive Vice President Visiting
Physician Association, US Medical Management, and David C. Vezina,
MBA, Chief Information Officer, US Medical Management.
Joan E. Valentine, RN, MSA
Executive Vice President
Visiting Physician Association
US Medical Management
David C Vezina, MBA
Chief Information Officer
US Medical Management

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Accountable Care Organizations (ACOs) are
an important business model of today’s
value-based care environment as they strive
to provide quality, efficiency, and improved
healthcare outcomes for patients.
In an ACO, healthcare providers and
hospitals come together with the shared
goals of reducing costs and increasing
patient satisfaction by providing high-quality
coordinated healthcare to Medicare patients.
ACOs Contribute to Success with Technology

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According to CMS the goal is to ensure that:
…patients get the right care at the right time
while avoiding unnecessary duplication of
services and preventing medical errors.”
The idea behind an ACO is that if providers
are incentivized to improve the health of their
patients over providing a large volume of
services, the cost of care will decrease.
When an ACO succeeds at delivering high-
quality care and reducing healthcare
spending, the ACO shares in the savings
achieved for the Medicare program.
ACOs Contribute to Success with Technology

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What anyone who has participated in an ACO
knows is that it is not always easy to get started.
These organizations often lack direction, and it
can be difficult to understand how to use data
toward actionable interventions in improving care.
Integrating real-time data and analytics into
provider workflows can ensure patients receive
the appropriate primary and preventative care,
improve ACO Measure performance, and save
Medicare money.
ACOs Contribute to Success with Technology

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Participants in both the ACO program or
Medicare Shared Savings Program (MSSP)
are subject to a number of Medicare quality
reporting requirements and performance
initiatives, such as the Merit-based
Incentive Payment System (MIPS).
An ACO’s quality composite score is
based on the performance of MIPS
Group Practice Reporting Option
(GPRO) best practice preventative
care and primary care measures.
Accountable Care Organizations:
Requirements for Success

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ACO participants may receive as high as a
four percent upward or downward payment
adjustment based on their quality
composite performance.
ACOs are successful when the organization
improves patient satisfaction, improves care
coordination, and reduces cost.
Accountable Care Organizations:
Requirements for Success

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ACOs are required to demonstrate quality through four domains:
1. Patient experience of care: Patients are given the Consumer
Assessment of Healthcare Providers and Systems (CAHPS)
survey to assess quality of experience.
2. Care coordination and patient safety: ACOs are assessed
based on outcomes measures including ED use, ambulatory
sensitive admissions, and readmissions.
3. Preventive health: Standard assessments and screenings
to increase early detection of various conditions, such as
colorectal and breast cancer.
4. At-risk populations: ACOs must meet nationally recognized
standards for patients with chronic diseases, such as diabetes,
heart failure, and chronic obstructive pulmonary disease.
Accountable Care Organizations:
Requirements for Success

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Participation in ACOs has been steadily
growing since 2012.
As shown in Figure 1, on the next slide,
more healthcare providers and hospitals are
participating in ACOs each year and their
average overall quality scores, as well as
performance payments are also rising.
Accountable Care Organizations:
Requirements for Success

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Accountable Care Organizations:
Requirements for Success
Figure 1: MSSP ACO Participation and Performance Payments. Source: CMS data

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Even though the accountable care organization
model continues to grow, implementing such a
model is no easy task.
On the next few slides are some common
challenges to successful implementation.
Challenges for ACOs

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Available technology is not set up to meet the needs of an ACO.
Challenges for ACOs
Investment in technology does not
automatically mean success.
An ACO needs to monitor EMR data,
clinical and claims data, and more.
A sophisticated analytics system is
necessary to meet the analytic needs of
an ACO’s quality reporting initiatives.

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Providers spend too much time on care coordination.
Challenges for ACOs
Time spent by providers to review
previous interventions is time-consuming.
The manual processes may not provide
the information needed at the point of
care and may even detract from
providers’ ability to focus on the patient.
Physicians can experience lowered job
satisfaction as a result.

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The organization’s financial viability is dependent upon shared savings.
Challenges for ACOs
An ACO’s success leads to fewer hospital
inpatient admissions, fewer procedures,
and less fee-for-service reimbursement.
There is often a dichotomy of trying to
keep a head out of a bed versus the
hospital’s need to keep heads in
beds for their financial performance.

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Widespread understanding about the impact of documentation on
measure performance is lacking.
Challenges for ACOs
Few providers understand which documentation
sources contribute to measure compliance, and
the complex patient may qualify for as many as
12 measures annually.

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Technology Enables Understanding
of Performance
Transforming from a transaction-based
system to a pay-for-performance based
systems is a difficult process.
Having the right technology and
investing in that technology can help
smooth the path forward for ACOs.
Steps to effectively implementing that
technology might include the following:

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1. Build the data repository with an analytics platform.
Technology Enables Understanding
of Performance
ACOs need something to bring all siloed
systems into one place so they have access
to they need once they have aggregated data.
This requires a robust analytics platform to
bring together all clinical, claims, and financial
data into one place.
Oftentimes, organizations have not had or
utilized claims data before implementing an
ACO, which can bring a wealth of knowledge
into an analytics platform.

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2. Bring data to the point of care.
Technology Enables Understanding
of Performance
Providers need to have a clear understanding
of requirements in order to make decisions
for patients that allow ACOs to meet quality
requirements.

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3. Analyze claims data, identify outliers, including successes and failures.
Technology Enables Understanding
of Performance
A robust analytics system allows ACOs
powerful insights into data that help them
meet quality metrics, such as the ability to
drill down to the provider, department, or
patient level, display the overall composite
score performance, or display individual
measure performance.

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3. Combine clinical claims, and quality data to identify opportunities
for improvement.
Technology Enables Understanding
of Performance
ACOs need to be able to prioritize opportunities
based on identifying high risk patients and high-
volume areas of inappropriate variation that
significantly drive costs in order to effectively
focus their resources.
They also need to develop meaningful metrics
for individual patient conditions (especially for
chronic diseases) and for population health
and wellbeing.
This requires a highly sophisticated and
flexible analytic system.

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More Tips for Success for ACOs
Successful participation in the ACO program
involves a lot of factors, beyond just technology.
Other insights from successful ACO models
include the following tips for success:
Conduct deep dives into each measure to ensure
data accuracy, including reaching out to CMS to
clarify measure requirements.
Conduct beta testing with providers and practice
managers to validate accuracy and usability.
Engage practice managers in active panel
management.
Clearly identify inclusion criteria, exclusion
criteria, and denominator for each measure.
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More Tips for Success for ACOs
Successful participation in the ACO program
involves a lot of factors, beyond just technology.
Other insights from successful ACO models
include the following tips for success:
Standardize provider workflow, including
documentation in the EMR.
Make sure providers have the information they
need to understand the measure, documentation
required to meet the measure, and location of
that documentations in the EMR.
Use an iterative process to identify and build
measures within the analytics applications.
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Summary
Healthcare organizations and providers increasingly
need to focus on the health of patient populations,
requiring care coordination and teamwork across
specialties and organizations.
A successful ACO model means the elimination
of siloed views in favor of a more expansive
and collaborative model of care delivery.
In order to be successful, an ACO must
address these challenges by leveraging a
robust analytics system to automate the
process of data gathering and analysis
and aligning data with ACO quality
reporting measures.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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Joan E. Valentine, RN, MSA is USMM’s Executive Vice President of Visiting Physician
Association. She is responsible for all Shared Savings Programs, Quality and Performance
Improvement, VPA House Calls Division, VPA Specialty Programs and VPA Diagnostics and
Lab. Prior to joining USMM, she held the position of Senior Director of Quality and Clinical
Operations for Tenet Health Care Corporation and Michigan Pioneer ACO.
Valentine has experience in both health plan as well as provider focused care. She was responsible
for development and implementation of multiple clinically integrated programs for Michigan Pioneer
ACO resulting in improved care coordination, quality and beneficiary satisfaction and a significant
reduction in cost of care. Valentine has served as an advisor to the Post-Acute Care Innovation and
Education team for the Center for Medicare and Medicaid Innovation as well as an Advisor and
speaker for the Advisory Board in Washington, DC. Valentine is a Michigan native with a Bachelor of
Science in Nursing degree from Wayne State University and a Master of Science in Administration
from Madonna University.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Joan E. Valentine, RN, MSA–
Executive Vice President, Visiting Physician Association, US Medical Management

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David Vezina is the Chief Information Officer for US Medical Management and has been
instrumental in developing the information systems that allows USMM to achieve high-quality
marks coupled with remarkable financial results from the only CMS-approved House Call
ACO. His unique perspective was developed from his over thirty-five years of healthcare
experience in finance, operations, information technology, and services support.
He has served in administrative roles in multiple settings—from military field hospitals to hospital
systems and physician practices, including home health, hospice and house calls.
He received his B.S. in Accounting and MBA in Management Information Systems from Wayne State
University and is a retired Army Medical Services Corp Officer.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
David C Vezina, MBA–
Chief Information Officer, US Medical Management

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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
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