Real-time data drives ACO effectiveness

Since Accountable Care Organizations (ACOs) first appeared in the industry, effective real-time information sharing has been a key factor in providing more efficient, high-quality care. In order for ACOs to reach their true potential, all organizations involved must become highly integrated communications machines.

SECONDS RATHER THAN DAYS

The plan's care management team then uses the information to proactively follow up with members to ensure appropriate aftercare.

For example, a 50-year-old male member was treated in the ED for a severe cut to his arm. The alert included a copy of his discharge instructions, which instructed the member to change his wound dressings and to schedule a follow-up appointment with his primary care physician (PCP). When the Network Health care management team called the member to follow up, managers learned he had not booked the PCP appointment and was having trouble managing his wound dressings.

Managers scheduled the member with his PCP, who then referred him to a surgeon because the cut required an additional repair procedure. The intervention potentially avoided further medical complications, such as infection or a return trip to the ED.

Since 2011, when Network Health first participated in the e-discharge program, it has received more than 3,000 real-time notifications. The instant access to records improves efficiency and reduces costs by allowing for follow up in a timely manner.

The plan is now expanding the program to include several other NEHEN participants. The data collected is also being analyzed to better understand overall use patterns for emergency services, which could potentially lead to new solutions to reduce avoidable ED visits and instead direct patients to appropriate care.

PLANS HAVE DISTINCT ROLES

The success of the program serves as proof that plans can be active players when it comes to finding innovative ways to improve the healthcare system. Health plans will have an opportunity to play an even greater role and take advantage of new technologies next month, when the new Massachusetts health information exchange is up and running.

Massachusetts is a pioneer of healthcare reform. The state has insured 98% of its residents, passed a ground-breaking bill to contain costs, and received federal funding to start a major electronic health records exchange. Programs like e-discharge will help those of us who work in the healthcare industry make these reforms a reality.

Christina Severin is president of Network Health, a not-for-profit plan contracted by the Commonwealth of Massachusetts to serve Medicaid and Medical Security Program populations.