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ACOs and aggregated data: Payer analytics comes to ACOs

I was reading through the the 42 CFR 425 Medicare Program: Medicare Shared Savings Program: Accountable Care Organizations yesterday in response to a client asking us about our Managed Services. Specifically thinking about II(C)(2) and data sharing.

The rule discusses data sharing between ACO participants and the government.  Generally, the gist of the following few sections suggests allowing the Secretary to share claims information on Medicare beneficiaries both at the point of enrollment as well as on an ongoing basis. Why?

First, having claims data at the point of enrollment helps ACOs satisfy other parts of the rule around creating personalized care plans, helping with care coordination and other changes in care processes that need to be made for that beneficiary–all focused on patient centered principles. The data could be personally identifiable of course.

Finally, on an ongoing basis, the data would be provided in detailed as well as aggregated form to help ACOs understand the total universe of care. Since an ACO may not actually provide all care services for a beneficiary (although the goal is to do as much as possible), obtaining beneficiary level claims data helps ACOs understand the complete picture. The rule goes on to describe how this data would be used in aggregate and in detail (Section 5 and 6):

  • Financial peformance modeling
  • Utilization management
  • Clinical management
  • Quality reporting
  • Care management/Care coordination

For example, if the ACO’s beneficiary population has a high rate of readmission, then a program could be put in place to improve discharge coordination to reduce readmissions.

Looking over the intended uses, none of which are new per se, it struck me that a  lot of Payer claims data analytics is now transitioning to the Provider community. Since ACOs are inherently about Providers, not Payers (which is the primary reason an ACO is not an HMO), the ACOs now need to do Payer analytics.

That’s what Ajilitee is really good at. And we can do this on a Managed Analytics basis so we can help ACOs rapidly get to market on ACO analytics at the beneficiary level. Most importantly, since we build our analytics environments on could computing platforms like Amazon, you only pay for what you need and it can grow to the size you want as the ACO grows.

That’s what struck me about Managed Analytics and the client conversation. With Ajilitee, Managed Analytics has a great promise to deliver capabilities that Payers have today cost efficiently to the Provider community immediately tomorrow.