The EHR is a prerequisite to forming an accountable care organization. But EHR data by itself is inadequate and providers need to form partnerships with payers to fill in the holes. That was one point driven home by Linda Fischetti, who serves as vice president, care delivery, Accountable Care Solutions, for Aetna. She spoke during the Nursing Informatics Symposium at the HIMSS13 Conference in New Orleans on Sunday, March 3.
The key to a successful ACO is being able to control overall costs for a population, she said, and that includes keeping high-risk patients in network as much as possible, avoiding what payers call “leakage,” or using services outside the core group of contracted providers. Aetna is developing ACO partnerships across the nation, she said, describing how the commercial payer assesses a provider’s infrastructure and care management programs before aligning. In its ACO partnerships, Aetna shares claims-based data with providers to help provide a bigger picture of patient activity. “We can show (an ACO collaborator) length-o- stay data from the hospital across the street,” Fischetti said. “They had never seen that. You begin to see the lights go on.”
Fischetti acknowledged that the vast number of ACOs and various ACO models can be confusing for providers—who must contend with quality and outcomes measures from multiple sources. “It’s very difficult to see consistency among multiple data sources, such as commercial payer claims, Medicare claims and your own EHR. So you should focus on trends instead of getting the numbers to match up. But the integration of claims and EHR data creates a new opportunity for quality improvement.”
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