The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

 

The Five Key Components of ACO Analytics

By Truven Staff

Accountable Care Organizations (ACOs) were created to provide financial incentives for providers to control costs and improve the quality of care. As they continue to advance, it is important for both providers and payers to ensure that risk is being appropriately shared between the two. This creates a unique set of challenges in determining the best way to design, manage and evaluate these programs. Whether you are running an ACO or contracting with one, data is integral to determining the best model. Without the proper data, those providing the care, and those paying for it, are flying blind.

What’s more, not all ACOs are created equal, with three general types of models accounting for the bulk of ACOs: employer-sponsored, employer-direct contracted, and those leveraging existing insurer relationships. The analytic tools used to evaluate performance will depend upon which type of relationship a payer has with the ACO.

The ACO Analytic “Tool Box”

The five analytic methods listed below are key for ACOs managing program performance, and for employers and health plans assessing the value they are obtaining from these programs.

1.       Attribution

All measurement depends on a connection made between the ACO and/or its providers and enrollees. As a result, we need to uncover who the enrollees are, and for whom the ACO is bearing risk.

Often, explicit patient assignment does not exist. Where it does, the evaluation models need to incorporate it into analytic databases. In the cases where it doesn’t, the ACO needs to perform that attribution based upon the observed pattern of care received by the patient population.

2.       Population Health Management

There are multiple tools available to identify and stratify patients, such as predictive modeling, where risk scores based on age, gender, and diagnosis are employed. Other methods employ biometric or health risk assessment information. Examples of these include Health and Longevity Scores, Health and Productivity Indexes, and Health Status/Opportunity Scores, that can be used to segment patient risk levels.

3.       Network Management

If an ACO is at financial risk for the management of individuals, it’s imperative to know where people are receiving health services, what kind of utilization is taking place out of network, and where those out-of-network services are being given.

Many beneficiaries are not locked into the ACO network, which makes knowing whether these services are being given by high quality, efficient providers paramount.

4.       Program Evaluation

It’s important for everyone involved through the continuum of care that an assessment be made on the effectiveness of the ACO. As anyone who has been involved in care evaluation can tell you, there are a host of methodological pitfalls that can throw a wrench into measuring program evaluation. Controlling for differences between populations – specifically those who use the ACO and those who do not – is exceedingly important to determine the effectiveness of that ACO.

5.       Quality Measurement

In addition to evaluating ACOs on the basis of financial performance, establishing core quality measures for ACOs enables us to glean insights we would otherwise not have. Metrics such as potentially-avoidable admissions, screening rates, and specific process and care measures give us a baseline for quality measurement that is imperative in defining how well the ACO is performing.

Embrace the Risk

Risk is a fact of life in healthcare; it always has been. But in this new landscape, the ways in which both providers and payers are sharing that risk has undergone a drastic shift. Everyone will assume risk, but as we’ve outlined above, the key is to understand and properly allocate that risk between providers, patients and payers. The data is there; to guide these decisions, the key is employing the appropriate tools to establish this balance.

John Azzolini
Senior Consulting Scientist


Can Personalized Healthcare Communications Really Drive Behavior? Yes, and Here’s How.

By Truven Staff
Matt Collins imageAsk any healthcare consumer, and there’s a 50-50 chance that they have little idea, without a call to their doctor, when they should have specific, preventive cancer screenings based on their age, or what their target cholesterol levels should be for their specific health history, or what happens if they don’t take their blood pressure medication every day.

In fact, recent studies by Truven Health Analytics experts found that at least half of healthcare consumers don’t get the care they need (as recommended by evidence-based guidelines) and up to 50 percent don’t take medication as prescribed. That lack of knowledge is translating into higher healthcare costs for employers and health plans, which trickle down to the consumer in a time when everyone’s worried about rising healthcare costs.

There is good news, though, and it comes in the form of highly personalized healthcare communications.

More and more studies, including one published in the Journal of Public Policy and Marketing, prove that engaging people with tailored, timely, and relevant messages about their health improvement opportunities can increase care compliance by 10 to 20 percent. That type of boost can save employers, health plans, and consumers significant amounts of money, thanks to early identification and cost avoidance.

When we talk about cutting-edge, customized healthcare messaging that produces results in the real world, it goes well beyond the “it’s time to think about a mammogram” to “it’s been two years since your last mammogram, and here’s why that’s especially dangerous for you, and we know you don’t want to put your family at risk, and here’s how to act on this information in the easiest and most cost-effective way possible.”

The foundation of that type of detailed communication is the use of targeted data, analytics, and market segmentation. Those elements must continually inform not only the basic message content, but also the tone, emotion, and other tactics.

A recently published Truven Health insights brief, Four Steps to Creating Healthcare Communications That Drive Behavior Change, discusses how to accomplish this by basing communications on a consumer-specific profile, using eligibility, medical claims, and other available data. Data might include age, gender, ethnicity, family structure, and medical and drug history. The next step is to assign each individual to a refined demographic, psychographic, and behavioral segment, so that tactics, images, emotion-level, and preferred communications channel can be versioned by what they prefer and how they tend to react and behave when it comes to healthcare decisions.

This process has been delivering an ROI of 3:1 or higher in many cases — a boon for helping employers and health plans achieve financial stability when trends continue to consistently increase. The best part, of course, is that consumers benefit, as well.

Full Personalized Healthcare Messaging Brief Available
, Four Steps to Creating Healthcare Communications that Drive Behavior Change.

Matthew Collins
Director of Product Management

Population Health Management: Employers' Role in Cancer Prevention and Treatment – Developing Success Metrics

By Truven Staff

Ron Goetzel imageRecently an article titled “Employers' Role in Cancer Prevention and Treatment—Developing Success Metrics for Use by the CEO Roundtable on Cancer,” appeared in Population Health Management, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. In this article, the authors discuss how employers can play a significant role in improving efforts to prevent and treat diseases, such as cancer, by introducing and supporting health promotion programs in the workplace.

 

 

Rachel Mosher Henke image The authors describe the “5 Pillars” of the CEO Cancer Gold Standard program, the framework Johnson & Johnson created to monitor the use and effectiveness of the cancer prevention and treatment enhancement efforts it introduced, and examples of the data collected by the company.


The article is available free for a limited time on the .

 



Ron Z. Goetzel, PhD
VP of Health & Productivity Research

Rachel Mosher Henke, PhD
Director of Research

EMRs Should Re-Engineer Medical Data Collection

By Truven Staff
Mike Taylor imageElectronic medical records . To fulfill the promise, EMRs need to lead the way in re-engineering the way medical information is collected, processed and utilized. This promise will not be fulfilled, however, if the EMR simply converts the paper medical record into an electronic record, using the same formats. EMRs should be able to solve the challenges of workflow automation and allow for a more mobile platform in which to collect data, but if an RN is now entering blood pressure into the EMR, much as was done in a paper record, is there any efficiency advantage for that RN? I would argue there is not.

Medical journals are now commenting about physician progress notes in the EMRs; many notes are simply copying all prior physician notes and pasting back into the record with a new date, making the notes redundant and meaningless. This is an example of trying to use the paper medical record format in an EMR environment.

EMRs need to allow for automated data entry from digitized sources, but the data need to be converted into medical information with decision support, gaps in care prompts, and other innovations to improve individual patient care. But even that is not enough. EMRs need to allow physicians, nurses, and other health care professionals to manage entire populations, not just the patient sitting in front of them at the time. This is the true promise of a fully integrated EMR. 

Dr. Michael Taylor
Chief Medical Officer

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