There’s no nice way to put it: IT leaders serving thousands of ACOs simply aren’t doing their best to enable their organizations to capitalize on the Medicare Shared Savings Program (MSSP) and other pay-for-performance (P4P) incentive programs.
This disappointing lack of engagement poses a serious problem to physician groups, thousands of whom missed opportunities and suffered penalties to their Medicare payments in 2016.
Fortunately, awareness of this problem has forced many ACOs to take proactive steps toward properly collecting and integrating their participants’ data in a timely manner.
But is your ACO one of them? If the answer is no, here are four things your ACO's IT leaders might not be doing—but should be—to realize the rewards your participants are working so diligently to earn.
- Your ACO’s IT leaders might not have a strategy for integrating their data sources properly. Your ACO needs a strategy for integration and interoperability. If your ACO can’t extract its participants’ data due to an inability to retrieve it from a certain brand of EMR and report it in the format that CMS requires, your ACO’s likelihood of earning a reward will dramatically decrease. This is due to the fact that, without proper integration, your ACO would have to rely on manual data collection and formatting—a time-consuming, labor-intensive process. Still, countless ACOs’ IT leaders don’t even think about this work until CMS issues a final notice, and by then, the opportunity is missed.
- Your ACO’s IT leaders might not be using monitoring tools. From each ACO participating in the MSSP, CMS randomly selects 616 patients for each measure (or the maximum number of eligible beneficiaries if fewer than 616 are available)—regardless if the ACO serves 1,000 or 100,000—and holds each of them to 18 of “the 34 quality measures used to assess ACO quality performance for the 2016 quality reporting year.” But your ACO shouldn’t simply cross its fingers and hope that each measure’s randomly selected 616 will represent the organization well. Instead, to improve the entire population’s care and their potential to positively represent the organization, your ACO’s IT leaders should use proper monitoring tools to programmatically address as many of those aforementioned 18 quality measures as possible throughout the year. For example, an ACO using monitoring tools that are informed by its participants’ well-integrated data sets can identify its population’s diabetics, isolate those who haven’t taken their annual dilated eye exam, and prompt them to take immediate action, thereby minimizing their personal risk while maximizing their potential to augment your ACO’s MSSP success.
- Your ACO’s IT leaders might not be enabling participants by giving them login credentials to essential tools. If you have to start contacting your ACO’s participants for their patients’ data after CMS identifies each measure’s randomly selected 616 subjects, the data collection process will be painfully manual, even chaotic. Instead, your ACO should give each participant a login to a tool that captures and automatically integrates a given patient’s data into the ACO’s collective data set. This will not only relieve your ACO of any haphazard data collection burdens later, it will logically place the initial reporting responsibility on the shoulders of the participants who are, after all, generating the data right from the start.
- Your ACO’s IT leaders might not be leveraging their MSSP experience and applying it to other contracts. Payers like Cigna, Humana, and many others have their own P4P arrangements that reward ACOs and their participants for improvements in quality and cost-efficiency, but if the management of the contract isn’t streamlined in a way that’s similar to the way it is for CMS, with all the data sources integrated, your ACO foregoes a real opportunity. Don’t let that happen. Instead, press your ACO’s IT leadership to repurpose the technical proficiency they’ll earn in their effort to satisfy CMS’s data demands for MSSP by applying that knowledge to fulfilling their incentivizing payers’ requests for P4P data.
Your ACO’s IT leaders’ commitment to taking action on these four items will have a significant impact on the well-being of your ACO’s MSSP scores and its potential to capitalize on other existing and forthcoming P4P programs. While providing the requested data is often a tedious process for many ACOs—so much so that thousands apparently prefer the missed opportunity over the prospect of undertaking the work to proactively report their data sources—your ACO doesn’t have to count itself among them.
Instead, your ACO’s IT leaders must seize the opportunity to augment the outcomes of your participants’ patients, bolster the profits of the participants themselves, and avoid altogether the hard-to-explain circumstances of how in the world your ACO managed to miss golden opportunities despite its participants’ better reputations.
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