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Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

Jan 22, 2015




the greatest challenge to ACO success is the misunderstandings created by the language we use. Baselining is a critical step to ensuring that both providers and payers are pulling in the same direction:
• What are the provider's patient population(s)?
• What criteria are we using to measure quality?
• What does “cost” mean? What is included in a service "cost”?
Once baselines are established, it’s critical that both providers and payers are monitoring these metrics regularly, so when gaps appear – which they will – adjustments can be made.

  • 1. Lets Talk Healthcare with Informatica and Edgewater: Bridging the Gap: Reaching Consensus on ACO MetricsSpecial guest: Senthil Balasubramanian, Manager, Decision Support, Penn MedicineRichard Cramer Maury DePaloMichelle BlackmerChief Healthcare Strategist Director, Healthcare Practice Director, Healthcare Product MarketingInformatica Edgewater Informatica1

2. Todays Agenda Bridging the Gap Achieving Better Data Alignment Bringing Together Quality & Financial Data Success Factors Aligning Quality & Financial Objectives Targeting Defined Patient Populations Reaching Consensus on Baseline Medical Expenditures Use Cases Combining Financial and Quality Performance Analytics Promoting Accountability across a Shared Process Model Q&A2 3. Use Case 1: Reporting & AnalyticsIntegrating Quality & Financial Performance & Risk ManagementBy Practice Area, By PhysicianSpecialty Care: Dr. RubensteinPrimary Care: Dr. Jamieson Cardiology Associates, Inc. Primary Care, Inc. By Service Types PMPM / Utilization / Adherence to Std / Clinical Risk / Financial RiskInpatientDOS ProcedureSubmit AmtPaid Amt OutpatientClaim Nbr: 2006-1001-001013/30/2006 CPT 770573/30/2006 CPT 88174 Claim TotalScreening Mammography, Bilateral ...Cytopathology (Liquid-Based)$$$105.00 45.00150.00 $ $ $95.0055.00 150.00 Claim Nbr: 2007-1310-003225/19/2007 CPT 77057 Screening Mammography, Bilateral ...$ 105.00 $95.005/19/2007 CPT 88174 Cytopathology (Liquid-Based)$45.00 $55.00 Claim Total$ 150.00 $ 150.00 Claim Nbr: 2009-1561-004517/30/2009 CPT 77057 Screening Mammography, Bilateral ...$ 105.00 $95.007/30/2009 CPT 88174 Cytopathology (Liquid-Based)$45.00 $45.00 Claim Total$ 150.00 $ 140.00 Claim Nbr: 2010-1833-00729 12/10/2010 CPT 88174 Cytopathology (Liquid-Based)$45.00 $45.00 12/19/2010 CPT 77057 Screening Mammography, Bilateral ...$ 105.00 $95.00Professional Fees Claim Total$ 150.00 $ 140.00 Normative DataProvider RadiologySpecificationPatientSpecification ProviderPeer GroupServiceLaboratorySpecification ? Provider A Result A LocationSpecification Provider B Result B OtherSpecification Provider C Result C Provider D Result D Year over Year, Quarterly, Monthly Performance Tracking By Time Frame3 4. Use Case 1: Reporting & Analytics Integrating Quality & Financial Performance & Risk Management TechnologySolutions & BenefitsData Integration Core Data Models Population ModelsMaster Data Management Primary Entity Reporting Segmentation Patients, Providers Patient Cohorts Charges, Costs, Stratification CriteriaPaymentsData Quality Management Continuum of Care PartnershipsModels & Analytics Gain / Loss / Risk Sharing Care Records: Incentive AlignmentReal-Time Events, AlertsDiagnoses, Treatments, Inter-Enterprise Data& Decision SupportOutcomes ArchitectureInformation LifecycleProcess Models Business ModelsManagement4 5. Use Case 2: Patient & Physician AttributionCollaborative, Patient-Centered Care Primary Hospital Care Groups SpecialtySNF, LTCGroups Physical Rehab TherapyPayersShared Accountability Shared Risks & Rewards Coordinated Delivery Platform5 6. Use Case 2: Patient & Physician AttributionTechnologySolutions & Benefits Data Integration Core Data Models Population Models Master Data Management Patient Navigation Triple Aim: Patient Access Metrics Healthy Population Quality & Satisfaction Per Capita Costs of Care Data Quality Management Care Setting Analytics Participants / Contributors PCMH / PCPCH Clinical Risk Models Patient Engagement Real-Time Events, Alerts Financial Risk Models Patient Experience & Decision Support Information LifecycleProcess ModelsBusiness Models Management6 7. Learn More. Register for the third webinar in the series Bridging the Gap: Reaching Consensus on ACO Metrics Wednesday, January 23, 2013 11:00am PT / 2:00pm ET Click here to view the other webinars in theseries Click here to sign up for alerts for futurewebinars in the series7

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