In the early stages of healthcare organizations migrating toward accountable and risk-based care, some are succeeding while others are not.
Success or failure with ACOs is dependent on several legacy experiences within an organization, such as whether the executive team has experience at managing risk, have the appropriate technologies, and have positioned the physician community to manage the change, says Jonathan Niloff, M.D, CMO at software vendor McKesson Corp.
Niloff knows the trials of population health management; in a previous life before McKesson during earlier attempts at managed care, he managed 500,000 lives and knows how to screw up, he told Health Data Management at HIMSS15.
In rolling out its accountable care programs, the Centers for Medicare and Medicaid Services has encountered such legacy experiences in not recognizing that various aspects of the Pioneer ACO and Shared Savings programs were not structured to allow participating providers to succeed in managing risk, Niloff says. As a result, the providers initially did not prospectively know who their patients were and how to guide them toward appropriate care.
However, next-generation rules from CMS in late 2014 started to fix those problems, particularly by offering up-front payments that significantly ease participants capital concerns as they gear up for accountable care, he adds.
Niloff notes some components that providers need from processes and technology to be successful with value-based contracts:
* They must be able to manage quality metrics in specific populations,
* They must have technology (analytics) to understand the key drivers of cost and utilization, and
* They must be able to understand practice pattern variations, manage ambulatory drugs, and the need to develop strategies and technology supporting patient engagement, along with a strategy to acquire, aggregate and normalize data to track progress, problems and trends.
McKesson recently moved its analytics, population health management and health information exchange operations into a single unit as it repositions to better support accountable care.
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