Accountable care organizations (ACOs) are evolving in their ability to measure the effectiveness of their efforts. This blog focuses on ACO analytics. It also reviews some insights from Modern Healthcare’s 3rd Annual ACO Survey and MedInsight analytic support of ACO effectiveness in care coordination.
Discussing results from Modern Healthcare’s ACO survey, the article titled “Still seeking best practices: Annual ACO survey shows care coordination remains a work in progress for many providers,” (subscription required) highlights both the progress and challenges facing ACOs at all levels of the ACO payment model, from providers to patients. The survey captured responses from over 35 ACOs across a variety of organizations including ACOs with and without hospitals, ranging in size from those that manage care for 553,000 covered lives to those with 5,600 covered lives. As noted in the article, as accountable care continues to expand and evolve, organizations seeking to embrace the payment model are experimenting with how best to measure the impact of critical strategies to improve patient care, including better care coordination.
To gain a better understanding of the care coordination measurements currently in place, Modern Healthcare added two new care coordination questions to this survey for the first time this year. They were: 1) Is care coordination measured? and 2) If so, name the ACO’s top five measures. The responses varied but it is clear that effective care coordination measures are still evolving.
While there are limited consistent measures across the spectrum of care coordination, there was consistent feedback from the respondents about what is currently used. Measures mentioned in the article and available in Milliman tools include:
• Readmission rates
• High-cost members
• Emergency department (ED) frequent visits
• Medication management
• Where patients received care, such as the emergency room, including the level of care
• Health promotion and education to monitor care coordination
• In-network coordination of care
• Patient engagement in care management
The patient engagement capabilities are available through the use of Milliman’s Enrollment Assessment and Survey tool. This is a web-based tool that includes three online survey tools that measure the level of engagement patients have in their own care, as well as the ability to track individuals and the related outreach made to members on a periodic basis, including action plans.
Below is an example of population level reporting for “in-network vs. out-of-network” emergency department (ED) visits. MedInsight uses the claim detail and the Milliman Heath Cost Guidelines analytic engine to efficiently bucket and identify the ED visits. Using this same engine and the MedInsight Analytic Cube, Figure 1 below delivers a report that provides a wealth of information about ED visits for a given population. In this example, the utilization of ED visits are split between in- and out-of-network visits, including the distribution of visits across each day of the week. Additionally, MedInsight provides additional metrics that provide further insight into the relationship between ED visits and inpatient admissions. Subsequent analysis may include:
• The review of admit hour to evaluate whether these visits were after hours or during normal office hours, highlighting education opportunities and access issues.
• Facility location of these ED visits.
• Evaluate the distribution of visits across the primary care physicians (PCPs) as well as members, to identify frequent visitors to the ED or specific patterns.
• Compare ED utilization to benchmarks: The percentage of admits from ED visits nationally is approximately 13%, according to CDC Fast Stats. More specific benchmarks, integrated into MedInsight reporting and analytics, are the Milliman Benchmarks, as shown in Figure 2 below.
Figure 1: ED Cases = In and out of ED, ED Visits Admitted = ED visit turned into IP Admit, ED Patient Visits = Total of ED Cases and ED Visits Admitted
Figure 2: Compares the ED Visits to 50% Degree of Health Care Management and Well Managed degree of health care management (degree of health care management is a measure of the level of management processes in place, e.g., case management, UM, disease management)
While real-time data is important for immediate care transition management, retrospective measures are also critical to evaluating success. MedInsight’s strength is to efficiently report cost and utilization detail at a population level as well as the ability to report on detailed member data. This provides access to several levels of analysis to more effectively manage and measure care coordination trends and analytics.
This article first appeared at Milliman MedInsight.
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