[University Affiliation]
Accountable Care Organizations (ACO)
ACO aims to facilitate cost effective and quality healthcare to individuals through developing appropriate linkages between different categories of healthcare systems, providers and institutions with the patients who are willing to be channelized through these entities. In order to ensure that the patient receives the right healthcare treatments and benefits especially with regard to cost and quality, there is need for integrating and sharing lot of specific information regarding the patient and associated aspects to and from multiple sources. The different instances of data exchanges required for integrating healthcare institutions, financial providers, insurance providers, etc with individuals for ensuring quality and cost effective healthcare solutions through the framework of ACO is explored in detail.
Data requirements for being a part of the ACO conglomerate
Primary aim of ACO is to provide comprehensive healthcare solutions to patients and it requires optimal levels of collaborations between different entities like healthcare systems, institutions, supporting organizations like insurance firms, large corporate and the potential target population. For the success of ACO initiative, large quanta of standardized “information” especially with regard to the beneficiaries has to be “networked between hospitals and other community health providers” (Health Care Provider Industry Report, 2012, p. 55). ACO conglomerate need to depend on different health care systems, payers and other related organizations for facilitating quality healthcare to its beneficiaries and so there is increased need to develop and standardize appropriate techniques and methods for accessing and sharing data. So data management especially with regard to collecting, optimizing and standardizing essential information, data exchange and data flow appears to be the key success factors.
Instances of data sharing
Primarily, information on the target patient population appears to be imperative for the effective functioning of ACO. Data regarding the beneficiaries or the potential target population, who are willing to participate in ACO program need to be collected, standardized and disseminated optimally based on need, in order to facilitate access to appropriate medical care from pertinent sources at the right times. Knowledge on the patient’s previous medical records are important to ACO for measuring the financial risks associated with each patient, which is dependent on different aspects like, age, illness, medical history, “socioeconomic status”, “disease registry”, etc (American Academy of Actuaries, 2011, p. 3). As different health care institutions that cooperate with ACO could be accessed by the target population based on need, suitable tools like electronic data systems has to be in place to generate data in a more standardized and unified manner. As the information regarding the patient’s health history and related aspects forms the major source of information that are accessed and updated at multiple levels, the need for standardizing the techniques right from data gathering levels appear to be imperative. In an ACO setup, beneficiaries would be accessing health care needs at multiple sources, each having their own distinct ways of data management. So there is need for adopting proper methods for standardizing or unifying the data systems of different health care providers for facilitating unrestrictive access to relevant data as well as to prevent duplication of the information or procedures (Burns & Pauly, 2012). Adopting compatible electronic systems by the different entities of the ACO conglomerate is essential as it improves accessibility and optimizes data utility.
Information on the various primary care physicians, healthcare experts in different areas of medicine, health care providers, institutions and systems that would collaborate with ACO has to be identified and recorded. This is for the purpose of understanding the capability, credibility and specialization of each entity and data on this aspect is relevant for planning and coordinating medical therapies and treatment scheduling as well as for ensuring its quality. Such data need to be accessed by the patients, financial supporters, insurance providers, healthcare providers, etc for ensuring that the patients are provided with the best possible healthcare option especially with regard to quality and cost (Klein, 2012).
The insurance companies need to provide details of the past claims made by the patients in order to assess the financial considerations associated with each beneficiary. Physicians, healthcare providers and payers could utilize these data to identify the risk categories of patients as well as for their effective management. Information on the resource utilization, treatments, procedures, disease management, finance management, the impact on the patient and their feedbacks are also essential parameters for assessing the performance of the ACO systems.
Need for standardization
As data from multiple sources and categories need to be accessed and utilized for facilitating cost effective and quality healthcare to the beneficiaries, it makes it relevant to standardize or harmonize the data. According to Klein (2012, p. 3) “improving the management of population health is data driven”, which indicates the significance of making the data extracts that are generated from diverse sources to be harmonized or made compatible. Or else relevant information remains underutilized and would result in the mismanagement of the healthcare.
Conclusion
Assessments on the various instances of data sharing at ACO revealed that the conglomerate of care providers could reach out and provide the beneficiaries with cost effective and quality healthcare only through optimizing data exchange and usage as well as through developing effective collaborations. As the data is generated from multiple sources there is need for standardizing and harmonizing the data systems. This in turn could improve the accessibility and usability of the data and could ensure proper delivery of care management objectives.
References
American Academy of Actuaries (2011). An Actuarial Perspective on Accountable Care Organizations. Issue Brief. Retrieved July 9, 2013, from http://www.actuary.org/files/publications/ACO_issue_brief.pdf
Burns, L. R. & Pauly, M. V. (2012). Accountable Care Organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s. Health Affairs, 31 (11): 2407-2416.
Health Care Provider Industry Report (2012). New horizons collaboration. Ernest and Young. Retrieved July 8, 2013, from http://www.amga.org/AboutAMGA/ACO/Articles/ACO_Development_Final.pdf
Klein, R. J. (2012). The pioneer ACO model: healthcare partners’ integrated approach to accountable care. CDMI Report. Retrieved July 9, 2013, from http://www.judithhurley.com/uploads/1/2/6/1/12619310/cdmi_sum12.pdf
