In this blog series, we have been outlining the path to collaborative care and sharing how to create an IT foundation for a successful ACO. 

This proven process for organizations to successfully re-architect their care delivery infrastructure to adopt new, value-based payment and care delivery models has been explained in a six-step process: the 6 A's. We have gone through the first five: the acquisition of data, aggregation of data, access to data, the adoption of system components and analytics. We now wrap up the series with our sixth and final A, action – the step that makes your ACO flourish.

Sometimes, the last mile, that final link between analytics and action, is the most challenging aspect of running an ACO for healthcare organizations and communities. While there may be plenty of data available to analyze, organizations often rely on non-timely claims data as the foundation for this analysis. Further, the delivery mechanism to the care coordinators and providers who can make a difference to patient outcomes is often in the form of weekly or monthly summary reports. This retrospective view will, by definition, limit the ability to affect the kinds of cost savings and quality improvement changes that ACOs are under pressure to achieve.

With an ACO IT infrastructure where all of the “Six A's” are integrated, effective data-driven action means giving providers and care coordinators the tools to integrate the actionable insights they gain from analytics and reports not only in a prospective manner, but also in a way that fits into their daily workflow. Imagine analytics that stratify your patient population and auto-enroll them onto condition-specific pathways with action items, deadlines, and owners.

Now imagine that these owners are automatically alerted as to the next step in the patient's care in whatever way suits their workflow – for example, a care coordinator owner may see an action item for a particular patient on a COPD pathway within the care coordination system or module he uses each day; a physician owner may be alerted via a text message or right within her EMR; and a patient may be alerted via email that there is a task awaiting his attention in the patient portal.

This personalization of action allows all stakeholders to work in the manner most efficient to them but with the added value derived from population and individual patient data analysis.

The essential IT infrastructure requirements for putting ACO data into action includes:

  • Some of the provider collaboration and patient communication technologies we have previously discussed, including secure messaging, EHR integration and multi-constituency portals
  • Care coordination workflow tools that enable care managers to deploy consistent care plans based on the patient and population data collected, which also communicate care plan progress to providers and patients

The IT infrastructure is a key enabler for organizations seeking to embrace the vision for ACO and achieve its goals. We are at the dawn of a golden age of healthcare, where as a nation and a global community, we have the opportunity to start to learn much more rapidly from all of the data we are gathering, and put those insights into action and actively start to measure the impacts for continuous improvement of care.